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NA VMED P-5088 



i UNITED STATES NATV^^ 

I Medical News Letter 



Vol. 45 



Friday, 16 April 1965 



No. 7 




CONTENTS 



Portrait of RADM E. C. KENNEY 



iti 



FEATURE ARTICLE 

What's New in the Management of Trauma I 

SPECIAL ARTICLES 

Tagged Specimens Aid Biotracking Studies 2 

Glaucoma, Tonometry and Visual Field Testing 4 

Letter to RADM Kenney 6 

FROM THE NOTE BOOK 

Urgent Training Notice 7 

MSC Officers Graduate 7 

ATTEN : Hospital Corpsmen and Dental Technicians 8 

Change of Title of MSC Section 8 

Model Ordinance Regulating Ambulance Service 8 

RADM McDonald Reelected President of Navy 

Mutual Aid Association 8 

DENTAL SECTION 

Mass Application of Stannous Fluoride Cariostasis in 

Naval Personnel 9 

Clinical Significance of Dehiscence and Fenestrations 1 2 

Smoking and Cancer of the Mouth, Pharynx and 

Larynx 14 

An Improved Self-Curing Acrylic Restoration 14 



Know Your Dental Corps 

Personnel and Professional Notes 

PREVENTIVE MEDICINE 

Influenza and Influenza-Like Illness 

Rubella in Contacts of Infants with Rubella-Asso- 
ciated Anomalies 

Shellfish-Associated Hepatitis 

Declaration of Helsinki 

Antimicrobial Prophylaxis for Individuals with a 

History of Rheumatic Fever 

Leech Repellent 

Know Your World 

NOTICE 

RESERVE SECTION 

Aerospace Medical Association 

LT Richard R. Shultz Receives Award 

MISCELLANY 

Procurement, Training, and Assignment of Pharmacy 

Technicians 

Changes in Army PG Courses 

Annual Anesthesiology Review Session for the 

Armed Services 

LCOL B. S. Ott Receives Award 



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United States Navy 
MEDICAL NEWS LETTER 



Vol. 45 



Friday, 16 April 1965 



No. 7 



Rear Admiral Robert B. Brown MC USN 
Surgeon General 

Rear Admiral R. O. Canada MC USN 
Deputy Surgeon General 

Captain M. W. Arnold MC USN (Ret), Editor 
William A. Kline, Managing Editor 

Contributing Editors 

Aviation Medicine Captain C, E. Wilbur MC USN 

Dental Section Captain C. A. Ostrom DC USN 

Occupational Medicine CDR N. E. Rosenwinkel MC USN 

Preventive Medicine Captain J. W. Millar MC USN 

Radiation Medicine CDR J. H. Schulte MC USN 

Reserve Section Captain C. Cummings MC USNR 

Submarine Medicine CDR J. H. Schulte MC USN 



Policy 
The U.S. Navy Medical News Letter is basically an 
official Medical Department publication inviting the 
attention of officers of the Medical Department of the 
Regular Navy and Naval Reserve to timely up-to-date 
items of official and professional interest relative to 
medicine, dentistry, and allied sciences. The amount 
of information used is only that necessary to inform 
adequately officers of the Medical Department of the 
existence and source of such information. The items 
used are neither intended to be, nor are they, sus- 



ceptible to use by any officer as a substitute for any 
item or article in its original form. All readers of the 
News Letter are urged to obtain the original of those 
items of particular interest to the individual. 

Change of Address 

Please forward changes of address for the News Letter 
to: Commanding Officer, U.S. Naval Medical School, 
National Naval Medical Center, Bethesda, Maryland 
20014, giving full name, rank, corps, and old and new 

addresses. 



FRONT COVER: The U.S. Naval Hospital, Corpus Christi, Texas (Official U.S. Navy Photograph) was 
commissioned on 1 July 1941 and at that time had accommodations for 545 beds. 

Located eleven miles from downtown Corpus Christi this hospital occupies 65.8 acres of land within the 
confines of the U.S. Naval Air Station. 

During Fiscal Year 1964, there were 3,286 admissions, to the hospital and some 55,000 outpatient visits. 
The pharmacy Service filled approximately 122,000 prescriptions. Laboratory procedures performed totaled 
81,027 tests. Radiological Service technicians made 45,255 x-rays and 1,066 fluoroscopic examinations. 
Births totaled 55 1 for the year. 

On 1 February 1964 a Regional Data Processing Center was activated and now includes: patient statistical 
data, workload data, stocking level data for supplies and cost accounting for Food Service. — Editor. 

The issuance of this publication approved by the Secretary of the Navy on 4 May 1964. 

U.S. NAVY MEDICAL NEWS LETTER 



WHAT'S NEW IN THE MANAGEMENT OF TRAUMA' 

CAPT B. Eiseman, MC USNR, Professor and Chairman, Department of Surgery, 
University of Kentucky Medical School, Lexington, Kentucky, 



INTRODUCTION 

The management of battle casualties is the single 
most important professional duty that distinguishes 
the medical corps of the armed services from their 
civilian professional colleagues. In times of peace this 
fact is often neglected. The disastrous medical exper- 
iences so common in the opening months of very 
new armed conflict attest to this senseless historical 
repetition. This problem and challenge now is more 
significant than ever before, for the conscientious 
medical officer must not only remember what was 
standard procedure for treatment of the wounded 
one-conflict ago, but also must try to remain current 
with the voluminous surgical and research literature. 
General medical officers or specialists in fields other 
than surgery cannot hope to remain intelligently cri- 
tical of the latest suggestions for the management 
of the injured. 

In subsequent issues of this periodical various 
civilian authorities (many of them reservists) will 
be asked to review in a brief and critical manner 
the current status of a new or controversial subject 
pertaining to the treatment of the injured. The re- 
views will be personal evaluations of the field in 
which the author is expert. They will provide a few 
key references but in the main will aim to provide 
a concise statement concerning a new method of 
casualty management; the physiologic background 
for its use; a critical evaluation of the laboratory 
and clinical data supporting its employment; and fin- 
ally, a personal evaluation by the author of the role 
this new therapeutic modality might play in the fu- 
ture management of the injured. 

LOW MOLECULAR WEIGHT DEXTRAN 

As a plasma volume expander, dextran is well 
known to physicians caring for the injured. The dex- 
tran which has been clinically available for the past 

* First of the new series of articles announced in the Newsletter 
Vol. 45, No. 6 of 26 March 1965. 



decade (the so-called Swedish- American clinical 
dextran) has an average molecular weight of 75,000. 
Its plasma volume expanding effect results from its 
oncotic activity. Chemically, dextran is a long chain 
glucose polymer produced by the action of a bacte- 
rium, Leuconostoc mesenteroides, on sucrose. The 
crude dextran so produced ishydrolyzed, purified and 
fractionated to a particular molecular weight range. 

Following World War II Gronwall and Ingelman 
noted that dextran fractions of high molecular 
weight caused an increase in erythrocyte sedimenta- 
tion rate and an increase in red cell aggregation 
in dogs. Later, Thorsen and Hint found that dex- 
trans below 59,000 molecular weight were capable 
of reversing such aggregation. Knisely had noted a 
similar phenomenon, which he termed sludging, to 
occur in the microcirculation of animals following 
various types of injury. Recently, Hardaway has em- 
phasized the role these cellular aggregates (as mi- 
crothrombi) might play in the pathogenesis of 
shock. He and others have recently directed attention 
to the importance of tissue perfusion at the cellular 
level in the etiology of shock. 

Following the observation that erythrocyte aggre- 
gation occurs after many types of bodily insult and 
that such aggregates could be prevented or reversed 
by the addition of the lower molecular weight frac- 
tions of dextran, there was interest in the use of 
such an agent in various clinical situations where 
an increase in tissue perfusion was required. A com- 
mercial laboratory in Uppsala Sweden prepared a 
10% intravenous infusion solution of dextran having 
an average molecular weight of 40,000 with 90% 
of the fractions being in the range of 10,000 to 
80,000. It is dissolved in either normal saline or 
in 5% dextrose in water.** 

Dextran-40,000, like the earlier clinical dextran 
(dextran-75,000), is a hyperoncotic solution 

** Rheomacrodex « (dextran-40,000) 



U.S. NAVY MEDICAL NEWS LETTER 



which acts to draw water into the vascular compart- 
ment. The plasma expansion produced by dextran- 
40,000 is actually greater that that produced by 
dextran-75,000 but, because of the more rapid ren- 
al clearance of the smaller molecules, this effect is 
of shorter duration. Gelin has noted that 50% of 
dextran-40,000 is cleared within 3-5 hours where- 
as only 35% of dextran-75,000 is cleared in the 
same interval. 

The unique therapeutic properties of dextran-40,- 
000 result from its ability to promote blood 
flow when such flow is decreased as a consequence 
of injury. It asserts such an action in at least two 
ways. First, by reason of its oncotic activity it draws 
water into the vascular compartment, thus diluting 
the suspension of erythrocytes. With a lowered hema- 
tocrit there is less resistance to flow. The second 
mechanism by which dextran-40,000 lowers vascu- 
lar resistance is by its ability to decrease or prevent 
erythrocyte aggregation. Following trauma, for re- 
sons by no means clear, the erythrocytes and other 
formed elements in the blood become sticky. By 
counteracting this, dextran-40,000 again reduces 
the resistance to flow. 

Since 1957 there have been numerous laboratory 
and clinical studies of dextran-40,000. It has been 
clinically evaluated in various types of shock where 
it is intended to increase perfusion of the vital tis- 
sues in vascular surgery to prevent the formation 
of thrombi with small vessel grafts or protheses in 
the heart-lung machine to prevent the formation of 



red cell aggregates which impede flow as well as 
to diminish the destruction of platelets which occurs 
during use of the pump, in cold injury, organ perfu- 
sion, various arterial insufficiencies, and many oth- 
ers. Many of the clinical studies have been uncon- 
trolled and the therapeutic effects of dextran-40,- 
000 have been difficult to evaluate objectively. 
In general, the reported studies have been enthu- 
siastic but confirmatory data of the superiority of 
dextran-40,000 over other available treatment 
methods is too seldom seen. In some clinical trials 
control infusion of dextran-75,000, 5% dextrose 
in water and normal saline should be employed. 

Unlike dextran-75,000 the low molecular weight 
dextran does not interfere with blood typing or 
cross-matching. Also, there is apparently no clini- 
cally significant effect on bleeding time so long as 
the manufacturers dosage recommendations are 
followed. 

CURRENT STATUS 

Dextran^l0,000 has not yet been approved by 
the Food and Drug Administration and is therefore 
available only for investigational use. While the phy- 
sician and surgeon should be aware of the unique 
properties of this new material, there is still a need 
for more controlled evaluations of it to establish its 
proper therapeutic usefulness. It is a substance of 
potential clinical value but there is insufficient evi- 
dence at this time to advocate its general use in 
the management of the injured. 



SPECIAL ARTICLES 

WHICH WAY DID THEY GO?— 
TAGGED SPECIMENS AID BIOTRACKING STUDIES 

Submitted by CDR H. D. Baldridge MSC USN, Naval Medical Research Institute, 
Bethesda, Maryland 20014. 



The migratory habits and number distribution of 
wildlife are best studied by means of observations 
on tagged or marked specimens which mingle freely 
in nature with others of their kind. Each year biolo- 
gists band, tag, or otherwise mark thousands of ani- 



mals and release them under controled conditions 
at known geographical location. Recapture of these 
specimens and the notation of time and location pro- 
vides data on ranging distances and speeds. Of inter- 
est to the Navy in particular are those tagging pro- 



U.S. NAVY MEDICAL NEWS LETTER 



grams associated with the fishes and birds of the 
sea. It is the purpose of this article to call attention 
to two such current programs being conducted in 
the realm of the seas and to invite the cooperation 
of Navy personnel throughout the world. 

It is interesting to note that during the 19th cen- 
tury infancy of the science of Marine Biology, medi- 
cal department personnel serving aboard ships of 
the United States Navy were responsible for gather- 
ing much of the data on natural history of the oceans 
used by American zoologists of that time. Research 
on the ecology and behavior of animals of the sea 
continues to welcome and profit from observations 
made by the trained eyes of shipboard personnel 
of the Navy. 

SHARKS — The Shark Research Panel of the Am- 
erican Institute of Biological Sciences is currently 
conducting an International Shark-Tagging Program 
under the sponsorship of the Biology Branch, Biolo- 
gical Sciences Division, of the Office of Naval Re- 
search. Study of the basic biology of sharks has been 
receiving a substantial amount of attention in recent 
years, and experimental or laboratory work on 
sharks may be expected to bring to light many new 
bits of information that will help in understanding 
them. But this is not enough. Information is needed 
on the distribution habits and on the movements 
of sharks in their natural environment. For practical 
reasons it is a matter of great interest to learn more 
about the larger species. 

Probably the best and fastest way to obtain the 
kinds of information needed is the tagging and re- 
leasing of tagged sharks. If a tagged shark is caught 
a second time, information is added to the store 
of knowledge about sharks. How much is learned 
depends to a great degree upon the quality of the 
records that are kept and made available in a data 
pool. It has been estimated that about 2500 sharks 
of various species were tagged last year in waters 
all over the world. 

Navy personnel, particularly off-duty crew mem- 
bers ashore and afloat who fish for a hobby or pas- 
time, might be in a position to provide some of the 
most important and informative returns. For the 
return of an AIBS tag from a captured shark, along 
with the information requested on the tag, the 
Shark-Tagging Information Center will forward a 
formal certificate of acknowledgement of assistance 
along with the standard tag reward of one dollar. 

Efforts of the Shark Research Panel tagging pro- 
gram have been designed to stimulate interest in 
shark tagging and to assist in obtaining returns by 



direct communication with individuals, fishing clubs, 
and industrial operations likely to be of assistance 
in catching tagged sharks. In addition, a bimonthly 
newsletter is distributed to publicize tagging activities 
and other matters of interest to investigators, cooper- 
ators, and fishermen. Assistance is also available to 
cooperators in obtaining satisfactory identification of 
sharks tagged or recaptured. Tags of standard de- 
sign are available to approved applicants, and reason- 
able assurance of priority in data publication is ex- 
tended to cooperators and investigators. 

Requests for information concerning this program 
and the availability of tags should be directed to 
Stewart Springer International Shark-Tagging Pro- 
gram, American Institute of Biological Sciences, 
3900 Wisconsin Avenue N.W. Washington, D. C. 
20016. 

SEABIRDS. Hundreds of thousands of far-travel- 
ing ocean birds of many kinds are being captured, 
marked, and released on mid-Pacific islands in a 
widespread study of seabird migration by the Smith- 
sonian Institution, Washington, D. C. Although it 
is known that some kinds of birds perform remar- 
kable annual migrations of 10,000 miles or more 
over the North and South Pacific Oceans, the regular 
travels of most species are unknown or poorly 
understood. 

To learn more about the migration of seabirds, 
Smithsonian ornithologists have captured and 
marked over 300,000 birds of 28 different kinds 
in the Central Pacific with standard, numbered, 
United States Fish and Wildlife Service aluminum 
legbands. Of these, over 60,000 have been marked 
with 4-inch colored plastic leg-streamers. 

Anyone coming into the possession of a banded 
dead bird in the Pacific or Indian Ocean areas is 
asked to cooperate by returning the band, together 
with the time and place of recovery, as instructed on 
the band. For live birds, only the band number to- 
gether with time and place of capture need be sent 
to the directed address, after which the bird should 
be liberated so that its further travel may be traced. 

Anyone sighting a bird with a colored leg-stream- 
er anywhere in the Pacific or Indian Ocean areas 
is asked to cooperate by recording the name or des- 
cription of the kind of bird wearing the streamer, 
the color of the streamer, the date seen, and the 
latitude and longitude or approximate location of 
the sighting. All information on birds with colored 
leg-streamers should be sent as soon as possible to 
the Division of Birds, Smithsonian Institution, Wash- 
ington, D. C. 20560. Requests for additional infor- 
mation concerning the seabird-tagging program 



U.S. NAVY MEDICAL NEWS LETTER 



should also be directed to this address. In return 
for sighting or recovery data, each cooperator will 
be advised where the banded or color-marked bird 
was tagged. 

Navy personnel, particularly those of deployed 
operating forces, are in a unique position to gready 



aid biotracking programs such as those described 
for sharks and seabirds. For this reason, it is asked 
that information concerning these programs be circu- 
lated widely. A notice in the ship or station news- 
paper would surely help to pass the word to local 
birdwatchers, beachcombers, and fishermen. 



GLAUCOMA, TONOMETRY AND VISUAL FIELD TESTING 



Recent changes in the Manual of the Medical 
Department impose the requirement for annual ton- 
ometric examination of all naval aviators 35 years 
of age and over. Since there are numerous hazards 
inherent in any glaucoma screening program, an at- 
tempt will be made to point up some of the more 
obvious ones not mentioned in ManMed. 

The Schiotz tonometer applied to the anesthetized 
cornea provides a measure of intraocular pressure 
relative to the time the measure is taken and the 
scleral rigidity factor. Since there are diurnal varia- 
tions in pressure and individual differences exist in 
adapting to fluid intake, a single measurement of 
intraocular pressure is not necessarily indicative of 
the presence or absence of glaucoma. 

Recent valid studies have demonstrated that the 
yield of a glaucoma screening program may be 
doubled by performing both a visual field test and 
tonometry, as compared to the results obtained with 
tonometry alone. In fact, the report emphasized that 
"of the 12 with open angle glaucoma, only four had 
abnormal Schiotz or applanation pressure reading 
on the first examination (screening) and two had 
abnormal readings only in the remaining pressure 
tests. The remaining six subjects had normal values 
in the entire battery of pressure tests on the first 
examination, and only on repeated follow-up did 
they demonstrate evidence of hypertension. All 12 
subjects were detected in the visual field test by the 
presence of an arcuate scotoma." 1 

Visual field tests recommended for use in conjunc- 
tion with tonometry in glaucoma screening programs 
include (1) tachistoscopic multiple pattern visual 
field screening devices and (2) the tangent screen. 
The Federal Supply Catalog, FSC Class 6515 lists 
items in both categories: FSN 6515-582-0444, Ta- 
chistoscope, Visual Field Testing; and relatively in- 
expensive tangent screens, FSN 6515-381-0690 
(Folding) or FSN 6515-381-0700 (Roller), Screen, 
Tangent, Eye Examining. While the multiple pattern 
device provides a gross estimate of the status of 

1. Armaly, Mansour F. ( M.D., "Glaucoma Tests; A Population 
Study", Sight Saving Review, 32(3), 1962. 



the visual field, and requires approximately four 
minutes per patient, the tangent screen provides, an 
accurate plot of the central field but requires more 
time and a trained examiner. Either technique meets 
the requirements for visual field screening. 

Contrary to the belief of many, the Schiotz tono- 
meter is not the only instrument which provides a 
measure of intraocular pressure. There are several 
applanation type instruments which measure intra- 
ocular pressure more accurately and more consistent- 
ly than the Schiotz identation type instrument. These 
are the electronic applanation type instruments 
which measure intraocular pressure more accurately 
and more consistently than the Schiotz identation 
type instrument. These are the electronic applana- 
tion devices (Mackay-Marg, Biotronics, Berkeley 
Instrument Co. Instruments), and the mechanical 
applanation unit, the Goldmann instrument which 
fits either the Haag-Streit or Thorpe Slit Lamps. 

In addition to errors inherent in the Schiotz in- 
strument, improper use of the tonometer, and scleral 
rigidity, another of the hazards of a mass screening 
program is the corneal damage inflicted on the unsus- 
pecting patient through poor technique. It is recog- 
nized that in many instances in the Navy, the test 
is accomplished by a hospital corpsman who is often 
not under the direct supervision of a professional 
examiner. Since optometry officers who are recent 
graduates, and other military optometrists who have 
attended courses on glaucoma detection have re- 
ceived training in the use of the Schiotz tonometer 
on the eye, it is suggested that in the absence of 
a medical officer who has been trained in the use 
of this instrument the optometry officer perform the 
examination. 

An important area which is not covered by 
ManMed 15-92 concerns the methods for sterilizing 
the tonometer. There are numerous devices on the 
market which can be used for maintaining some 
semblance of sterility of the tonometer footplate and 
plunger tip — the only parts which touch the eye. 
The various devices use ultra-violet radiation, heat, 



U.S. NAVY MEDICAL NEWS LETTER 



or chemicals for sterilization. When ether, alcohol, 
or benzalkonium chloride (1:3000) are used, the 
instrument must be carefully rinsed with distilled wa- 
ter. A commercially available item called "Ton- 
ofilm" may be used. This is a latex tip which is 
applied over the footplate of the tonometer. Use 
of this device is presumed to preclude bacterial con- 
tamination of the cornea by the tonometer. "Ton- 
ofilm" is a rather expensive item — $.25 each in 
package of 100. 



In summary: (1) for maximum yield, a glaucoma 
screening program should include both visual field 
testing and tonometry (2) testing should be per- 
formed only by trained professional (3) Tonometry 
may be accomplished with any of several devices 
available (4) visual field tests may be performed 
using a tangent screen or a multiple pattern field 
testing device (5) tonometers must be kept clean, 
sterilized and in adjustment. 

—Optometry, Code 3121, BUMED. 



RHEUMATIC FEVER CONCEPTS 

In persons susceptible to rheumatic fever, massive 
monthly injections of penicillin, rather than small 
daily doses, do a better job in preventing streptococ- 
cal throat infections, and sulfadiazine pills are as 
effective as the more expensive penicillin. The extent 
of permanent heart change does not depend on the 
number of rhumatic fever attacks; if damage is go- 
ing to occur, it will be as a result of the first attack. 
Absence of a sore throat does not mean there is no 
"strep" infection; nor does the presence of one ne- 
cessarily indicate "strep" infection. 

These findings which refute some generally ac- 
cepted concepts, resulted from a 10-year study con- 
ducted by Irvington House, a New York City volun- 
tary agency (reported in a 1964 supplement to An- 
nals of Internal Medicine). — Public Health Reports 
80(1): 10, January 1965. 

S. C. CAMPAIGN ON DISEASE 

The County of Greenville, S. C, seeks to immun- 
ize all its citizens agaist poliomyelitis, DPT, and 
smallpox. It hopes to establish a program whereby 
each county resident will begin immunizations at the 
age of 6 to 8 weeks, complete them on schedule, 
and maintain them throughout life. Residents will 
be encouraged to make up immunizations they have 
missed. 

As part of an investigation of a widespread fungus 
infection that caused 40 cases of erythema multi- 
forme in the town of Greenwood, S. C, the Public 
Health Service gave high school and junior high 
school students skin tests. Erythema multiforme, a 
rare disease, is believed related to histoplasmosis. — 
Public Health Reports 80(1): 10, January 1965. 

CLEFT PALATE CLINICAL RESEARCH CENTER 

The largest clinical research center in the United 
States for the study of cleft lip and palate will be 
established at the Lancaster Cleft Palate Clinic, Lan- 
caster, Pa., under a grant from the Public Health 
Service's National Institute of Dental Research. 



Dr. Herbert K. Cooper, founder and director of 
the Lancaster Clinic, will conduct the comprehensive 
research program, studying the oral birth defect 
from its origin to its treatment. He will head a team 
which will probe factors that may cause cleft palate 
and cleft lip, evaluate surgical and dental procedures 
to correct the deformity and habilitate speech, and 
test the psychological effects on patients and their 
families.— Public Health Reports 80(1): 59, Jan- 
uary 1965. 

PHYSICAL EXERCISE FOR HEART PATIENTS 

A research project at Donolo Institute of Physiolo- 
gical Hygiene in Jaffa, Israel, backed by the Voca- 
tional Rehabilitation Administration, Department of 
Health, Education, and Welfare, seeks to get heart 
patients back on the job by having them engage 
in physical exercise. 

Daniel Brunner M. D., its director, says that sur- 
veys in Israel have indicated that incidence of heart 
attacks in sedentary workers was three times greater 
than among nonsedentary groups subjected to simi- 
lar diets and living conditions on an Israeli kibbutz, 
or communal farm. Followup studies, he says, show 
that ex-patients in hard-labor jobs had a greater sur- 
vival rate then those who were sedentary after their 
attacks. 

Researchers in the present project are doing lar- 
ger-scale followup to buttress earlier findings. In ad- 
dition the project is developing a course of gradual- 
physical training for about 100 heart patients, first 
with exercises and subsequently with sports. 

Mary E. Switzer, U. S. Commissioner of Voca- 
tional Rehabilitation, comments that "This project 
like many others the Vocational Rehabilitation Ad- 
ministration is backing in nine foreign countries, is 
a good example of how VRA can work to benefit 
the people of foreign lands, while, at the same time, 
gaining insight into problems which are of the ut- 
most importance in rehabilitation work here at 
home." — Public Health Reports 80(1) : 46, January 
1965. 



U.S. NAVY MEDICAL NEWS LETTER 



U.S. NAVAL HOSPITAL 

Fleet Post Office 
San Francisco, California 96662 



NH37:18:REF/ku 

5720/1 
Ser 1428 

15 February 1965 



Rear Admiral E. C. Kenney MC USN 
Surgeon General 
Bureau of Medicine & Surgery 
Department of the Navy 
Washington 25, D. C. 



Dear Admiral Kenney: 



On 12 March 1965, the U. S. Naval Hospital, Yokosuka, Japan, will hold com- 
mencement exercises for the sixteen Japanese interns who will have successfully 
completed their year of internship training on that date. These young physicians 
were specifically recommended by the Dean and the leading professors of their 
medical school. Thereafter, they were representatives of the 42 successful candi- 
dates for the Tri-Service Internship offered in Japan. They thus represent the 
most qualified of all Japanese medical students. They have not been found wanting 
in their year of training. It has been most gratifying to observe their professional 
advancement during this year. Twelve of sixteen interns have received permanent 
certification by the Educational Council for the Foreign Medical Graduates; the 
others, we predict, will be successful in a repeat examination this fall. We have 
also learned from them some of the interesting social and cultural customs of the 
Japanese, thus contributing to a very effective People-to-People Program. 

It is with pleasure that I commend their action to you, 

Very respectfully, 

S/E. P. IRONS 

CAPT MC USN 
Commanding Officer 



U.S. NAVY MEDICAL NEWS LETTER 



FROM THE NOTE BOOK 



URGENT TRAINING NOTICE 

APPLICATIONS FOR INSERVICE 

RESIDENCY TRAINING 1966-1967 

Interested applicants for inservice residency train- 
ing, should carefully review BUMEDINST 
1520. IOC for information concerning programs 
offered and procedure for submitting applications. 

Deadline for submission of inservice and outser- 
vice training programs to begin in the summer and 
fall of 1966 is 1 July 1965. Candidates will be no- 
tified of selection or nonselection as soon thereafter 
as possible. Applications, submitted via chain of 
command, should be for the full training program 
as outlined in BUMEDINST 1520.10C. 

Combined programs, such as in Neurosurgery, 
should be requested for the inservice portion first 
to begin in the summer of 1966, with the civilian 
portion to follow in a civilian institution to be 
determined. 

Applicants are encouraged to list at least three 
choices of naval hospitals for location of training 
if such choices exist in the chosen specialty, and 
may feel free to write the chiefs of services for 
details of the training offered, if desired. 



Early submission of applications is recommended 
to assure processing through chain of command and 
receipt in BuMed prior to the 1 July 1965 deadline. 
—Training Branch, BUMED. 

MSC OFFICERS GRADUATE 

Sixteen Medical Service Corps officers were a- 
mong The George Washington University graduates 
at the Winter Convocation in Constitution Hall, 
Washington, D. C, on 22 February 1965. These 
officers earned their degree primarily as a result of 
their efforts through participation in part-time, off- 
duty courses of instruction. In several cases however, 
the degree was earned as a result of a cooperative 
program authorized by BuMed in August 1960 with 
The George Washington University that provided for 
the establishment of an off-campus center of The 
College of General Studies at the U.S. Naval School 
of Hospital Administration, Bethesda, Maryland. 
Since that time, 142 Medical Service Corps officers 
have graduated from that course and more than 80% 
of those officers have completed, or are working to- 
ward, their degree. 

The following officers were awarded degrees as 
indicated: 



Master of Arts — Personnel Administration 
LT Lewis E. Angelo BUMED (Code 3142) 

Master of Arts — Financial Management 
LCDR Alan D. Bauerschmidt NNMC 



Bachelor of Arts — General 

*LCDR Alan D. Bauerschmidt 

LT Ronald R. Bolton 
*LT Donald E. Brouillette, Sr. 
*LT Joseph D. Cicero 

LT Max Leon Cooper 

LT Bruce J. Dietz 

LTJG Emile N. Giard 

LT James H. Herrin 
*LT Kenneth F. Hines 
*LT Howard D. Madison 
*LT Joseph R. Mulvey 
*LT Jack A. Nelson 

LT Langston E. Richardson 
* Degree awarded 30 September 1964. 



Curriculum 

NNMC 

NNMC 

NH, Newport 

NH, Chelsea 

NH, Bethesda 

BUMED (Code 482) 

NMS, NNMC 

BUMED (Code 13) 

PG School, Monterey 

PG School, Monterey 

NH, Oakland 

NNMC 

NH, Quantico 



U.S. NAVY MEDICAL NEWS LETTER 



Bachelor of Arts — Business Administration 



LT William J. Auton 
LT Charles R. Mountain 

All Medical Service Corps officers are urged to 
pursue their education which will be sponsored by 
BuMed under the provisions of BuMed Instruction 
150O.7A, These officers should also familiarize them- 
selves with BuMed Instruction 1520.12B which out- 
lines the Bureau's policy in making selections for 
assignment to full-time duty under instruction. 

The above listed officers are commended for their 
academic achievement, and deserve a traditional 
Navy "well done" for their accomplishments. 

—Code 35, BUMED. 

ATTENTION: HOSPITAL CORPSMEN 
AND DENTAL TECHNICIANS 

Hospital Corpsmen and Dental Technicians who 
took the Officer Selection Battery Tests for the FY 
66 Medical Service Corps in-service procurement 
program outlined in BUPERSINST 1520.15F, may 
obtain the result of their scores by submitting a re- 
quest to the Chief of the Bureau of Naval Personnel 
(ATTN: Pers B-623). 

CHANGE OF TITLE OF MSC SECTION 

The Secretary of the Navy recently approved a 
change in the title of the WOMEN'S Specialist Sec- 
tion of the Medical Service Corps to the Medical 
Specialist Section. This change will allow the ap- 
pointment of qualified male physical therapists, oc- 
cupational therapists and dietitians in the Navy 
Medical Service Corps. Heretofore, appointments in 
these specialties have been restricted to women. To 
further enhance recruiting efforts for dietitians, the 
Navy will now sponsor qualified dietetic students 
during their final 24 months of professional training, 
including a dietetic internship. It is believed that 
the above changes will result in an increase in the 
number of physical therapists, occupational thera- 
pists, and dietitians appointed, and will permit more 
realistic staffing in naval hospitals for these special- 
ties. — Medical Service Corps Division, BUMED. 

MODEL ORDINANCE REGULATING 
AMBULANCE SERVICE 

The Division of Accident Prevention of the Public 
Health Service, USDHEW, has reproduced "A Mo- 
del Ordinance Regulating Ambulance Service" for 
distribution to State and local health authorities to 



AdCom, Great Lakes 
NH, Guam 

promote uniformity and to improve local emergency 
medical services and facilities throughout the United 
States. 

The ordinance was developed by the Joint Action 
Program of the American College of Surgeons, the 
American Association for the Surgery of Trauma, 
and the National Safety Council. This model act 
covers the regulation of licensing, inspection and 
operation of ambulances, and sets standards or the 
licensing of ambulances and of ambulance drivers, 
attendants and attendant-drivers. 

In working cooperatively with the members of the 
Joint Action Program, ambulance and rescue asso- 
ciations, and other groups concerned, the Public 
Health Service has been sponsoring Emergency Medi- 
cal Services studies, surveys and training programs. 

The ultimate goal of all the participating groups 
is to assure the American public of the best possible 
emergency medical care for the injured and critically 
ill. 

Copies of the model ordinance may be obtained 
by writing to the Chief, Emergency Medical Servi- 
ces, Division of Accident Prevention, Public Health 
Service, U. S. Department of Health, Education, and 
Welfare, Washington, D. C. 20201. (PHS, DHEW 
News Release, 20 Feb 1965.) 

ADMIRAL McDONALD REELECTED 

PRESIDENT OF NAVY MUTUAL AID 

ASSOCIATION 

The Board of Directors of the Navy Mutual Aid 
Association at their Annual Meeting on 19 Feb- 
ruary 1965 announced the reelection of Admiral 
David L. McDonald USN, as President. Other offi- 
cers elected by the membership were Rear Admiral 
A. H. Van Keuren USN (Ret.), First Vice President; 
Vice Admiral V. R. Murphy USN (Ret), Second 
Vice President; Lieutenant General C. H. Hayes 
USMC third Vice President; Vice Admiral K. K. 
Cowart, USCG (Ret), Fourth Vice President; and 
Captain P. R. Engle MC USN, Vice President- 
Medical Director. 

Elected to the Board of Directors were: 
Rear Admiral L. A. Bachman USN (Ret) 
Admiral Arleigh Burke USN (Ret) 
Rear Admiral J. O. Cobb USN 
Rear Admiral P. Corradi CEC USN 



8 



U.S. NAVY MEDICAL NEWS LETTER 



Rear Admiral J. W. Crumpacker SC USN 
Rear Admiral J. B. Heffeman USN (Ret) 
Captain J. W, Higgins Jr. USN 
Rear Admiral W. I. Martin USN 
Rear Admiral R. L. Moore Jr. USN 
Captain G. D. O'Brien USNR 
Captain W. H. Schleef SC USN 
Rear Admiral A. M. Stiinn USN 
Brigadier General J. L. Stewart USMC 

The Board of Directors reappointed Captain T. M. 
Davis USN (Ret), as Secretary and Treasurer, and 
Lieutenant Commander M. E. Koepke MSC USN 
(Ret) as Assistant Secretary and Treasurer. 

Vice Admiral V. R. Murphy, USN, Ret., was con- 
tinued in office as Chairman of the Finance Commit- 
tee; Vice Admiral K. K. Cowart, USCG, Ret., as 



Chairman of the Membership Committee; and, Rear 
Admiral L. A. Bachman, USN, Ret., as Chairman 
of the By -Laws Committee. 

The Cha?e Manhattan Bank of New York was 
continued as investment counsel for the Association 
and the Morgan Guaranty Trust Company of New 
York retains custody of the Association's securities. 
The actuarial firm of Bowles, Andrews & Towne of 
Richmond, Virginia, will continue to serve as the 
Association's actuarial advisor. 

Captain Davis reported that in 1964, the total 
death benefit for Regular members was increased 
from $10,000 to $11,000 at no increase in cost. 
Also, an additional death benefit was established for 
Junior members at the Coast Guard and Naval 
Academies, making that total death benefit $10,000 
without an increase in cost. Navy Mutual Aid mem- 
bership at the end of 1964 exceeded 44,000 and 
the Association's assets exceeded $76,000,000. 



DENTAL SECTION 

MASS APPLICATION OF STANNOUS FLUORIDE 
CARIOSTASIS IN NAVAL PERSONNEL 

RADM Frank M. Kyes, DC USN*, Bureau of Medicine and Surgery, Navy De- 
partment, Washington, D.C. 



Legendary Gordius, king of ancient Phrygia, tied 
an exceedingly complicated knot on the yoke of 
his chariot. The oracles said that the man who 
loosed that knot would go on to rule all Asia. This 
was accomplished by Alexander the Great who 
CUT the knot with his sword. Thus developed the 
term "Gordian knot" — a difficulty which can be 
overcome only by bold strokes. I believe that a few 
bold strokes applied now will solve our dilemma 
in Armed Forces dentistry within a few years. There 
are three steps we must take: two of them are in 
the face of cherished tradition; and the third is to 
conduct the research, development, test and evalua- 
tion necessary to develop an effective system for 
annual application of stannous fluoride in three 



* Presented by the Assistant Chief of the Bureau of Medicine and 
Surgery (Dentistry), and Chief of the Dental Division, before the 
Dental Section at the 7lst Annual Meeting of the Association ot 
Military Surgeons of the U.S., Washington D.C, 20-22 October, 
1964. 



agents in all Armed Forces personnel. 

The first step was initiated ten years ago and pro- 
ven valid in the limited population of the U. S. Naval 
Academy. The second step was initiated six years 
ago in the recruit population at the U.S. Naval 
Training Center, Great Lakes; and to date it has 
limited acceptance in the Naval Dental Corps. The 
third step is in an active problem of research, devel- 
opment, test and evaluation in seven selected naval 
activities. 

PREFERENTIAL TREATMENT OF EARLY 
LESIONS 

The U.S. Naval Academy, with approximately 
4,000 members in the Brigade of Midshipmen, and 
an amply staffed dental department, presents an ex- 
citing story on the effect of a deliberate program 
of preferential treatment of early caries lesions. 



U.S. NAVY MEDICAL NEWS LETTER 



Ten years ago, because of circumstances beyond 
the control of the dental department, dentistry at 
the Naval Academy temporarily became, as the Su- 
perintendent expressed it, "A crash program on the 
first class" — meaning the graduating seniors. It was 
indeed that. As one strode through the clinic, the 
effects of delayed treatment during the preceding 
three years was apparent at a glance. Extractions 
and pulp-cappings were frequent. Most of the cavi- 
ties restored were both deep and large. The sick 
call each morning, consisting of patients suffering 
pain, frequently ran over a score and presented a 
daily administrative and professional problem. Be- 
cause of the concentration on completing the dental 
treatment needs of the first class before graduation, 
little time was left for routine treatment of the three 
lower classes. It was recognized that this concentra- 
tion on the first class was self-defeating in that the 
delay in treatment of the junior classes would permit 
their dental needs to progress to the same advanced 
stage as that of the first class. 

Ten years ago, it was decided to reverse this situa- 
tion. Emphasis on completion of dental treatment 
was placed first on the fourth class; and any addi- 
tional capability of the dental department was then 
given to the more advanced classes, even to the ex- 
tent, if necessary, of letting some seniors graduate 
with uncompleted work. 

In less than two years, this bore fruit. Preferential 
treatment of minimal lesions proved so effective that 
all operative dentistry was accomplished in each 
class, and all in the form of smaller restorations. 
More teeth were restored. There were fewer extrac- 
tions and fewer pulp-cappings. The benefit was 
also obtained in the dental officer distribution. In 
a ten-year transition, we have been able to reduce 
the total number of dental officers, to add the capa- 
bility of a periodontist and an orthodontist, and to 
reduce the number of officers assigned to operative 
dentistry from 12 to 8. 

THE CEMENT ALLOY PROGRAM 

Preferential treatment of early lesions was rela- 
tively easy at the Naval Academy because it was 
limited to only 4,000 men whom we had available at 
the same place for four years. This principle could 
not be applied to a Navy of 850,000 men, of which 
125,000 are recruits each year and who, after only 
nine weeks of recruit training, go on to duty in 
unpredictable ships and stations. 

In the beginning of this paper, I said that there 
were three distinct steps toward an effective Armed 
Forces preventive dentistry program. The first step 



was preferential treatment of small caries lesions, 
even at the expense of postponing treatment of exist- 
ing advanced lesions. Now we come to the second 
step and this one we should take — even at the ex- 
pense of a cherished tradition. This step we call 
the Cement-Alloy Program, restorations made of 
equal parts of cement and alloy. The principle is 
not new. Kronfeld 1 and Orban 2 recommended that 
radical removal of carious dentin should be avoided 
and that cariostatic temporary restorations should 
be placed over remaining carious dentin to stimulate 
development of secondary and sclerotic dentin. This 
long recognized conservative procedure is currently 
called an "indirect pulp-capping. 3 Recent research 
reports have shown a higher percent of success from 
indirect than from direct pulp-capping. 4 ' 5 About six 
years ago, at the U.S. Naval Training Center, Great 
Lakes, we modified this pulp conservation procedure 
to the use of the cement alloy restoration to arrest 
existing caries lesions which we would not otherwise 
have been able to complete in the thousands of re- 
cruits during their short nine-week recruit training 
period. We did this in full confidence that those 
cement alloys would conserve the pulp and prevent 
further breakdown of those teeth for up to two years; 
and we did this in full confidence that the dental 
department at each recruit's next duty station would 
find the pulps of those teeth in better condition and 
would be able to complete the restoration. In the 
cement alloy program, the cavities are opened up as 
necessary with no special attention to cavity outline. 
If possible, all caries is removed, and a sedative 
cement base is placed as necessary. When carious 
exposure of the pulp appears likely, an indirect pulp- 
capping with remaining carious dentin is recorded in 
the patient's record. 

We have received mixed reactions to this pro- 
gram. Some dental officers are strongly in favor of 
this conservative practice; others are highly critical. 
I respect the opinion of those critics but I believe 
they are wrong. I recognize that this practice is con- 
trary to the cherished professional tradition that each 
restoration must be a jewel in itself. In the Navy, 
the recruit input is so tremendous that we should 
first arrest all dental caries and then go on to finer 
permanent restoration. It is necessary to use some 
cement alloys to hold selected caries lesions at a 
standstill — until a subsequent dental facility will be 
able to complete the treatment using the cement al- 
loy as a base when the record shows that all caries 
was removed; or in an indirect pulp-capping, to re- 
move it after about six months, prior to permanent 
restoration. 



10 



U.S. NAVY MEDICAL NEWS LETTER 



ANNUAL APPLICATION OF STANNOUS 
FLUORIDE 

The third important step is to develop an effective 
method for providing the benefits of annual three 
agent stannous fluoride treatment to all personnel. 
It will interest you that the first full year data of 
our clinical study at the U.S. Naval Submarine Medi- 
cal Center, New London, has been completed. In 
138 men, upwards of 70 per cent reduction in new 
DMFT (decayed, missing, filled teeth) was observed 
after one year, and in 50 men, after two years, up- 
wards of 80 per cent reduction was seen. The treat- 
ment which produced this dramatic reduction con- 
sisted of stannous fluoride in three agents: a rubber 
cup prophylaxis using 17.5 per cent stannous fluo- 
ride in lava pumice; topical application of 10 per 
cent stannous fluoride; and provision of stannous 
fluoride dentifrice for daily home use. After indepen- 
dent consultants have analyzed the data, a complete 
report will be offered for publication. 

This 70 to 80 per cent reduction was no surprise. 
It was forecast by the preliminary results of March 
1963 n . Those highly encouraging preliminary re- 
sults led to serious thinking about how our Naval 
Dental Corps would be able to provide this three 
agent stannous fluoride benefit to all naval person- 
nel. In this technic, the rubber cup prophylaxis takes 
the most chair time. If we could eliminate that 30 
minutes' chair time by using an alternate stannous 
fluoride prophylaxis technic, we could come much 
closer to the capability of providing annual three 
agent stannous fluoride to all hands. Chemists ad- 
vised us that it apparently was the burnishing of 
stannous fluoride on the clean enamel surface which 
caused the tin and fluoride uptake in the enamel. 
If the subject, using his own toothbrush and the 
stannous fluoride lava pumice mixture, could clean 
his enamel surfaces as well as the average dental 
technician using a rubber cup, then his "self-prophy- 
laxis" should cause a similar tin and fluoride uptake. 
On this line of reasoning, a clinical study was con- 
ducted at the U.S. Naval Dental Clinic, Norfolk. 
They found that groups of ten subjects under the 
supervision of one dental technician, and brushing 
their teeth for ten minutes, were able to clean their 
enamel surfaces essentially as well as the average 
dental technician with a handpiece mounted rubber 
cup. This was demonstrated by the basic fuchsin 
stain and scoring of remaining plaque. These data 
have been accepted by the Journal of the American 
Dental Association for publication. 

After this encouraging information, the Dental 



Research Facility, Great Lakes, initiated a study to 
determine the tin and fluoride uptake in enamel after 
self-prophylaxis, using biochemical analysis of ex- 
tracted teeth. Bizarre results in the first trial appa- 
rently resulted from experimental error; and this trial 
is being repeated. A clinical study designed to com- 
pare cariostasis form stannous fluoride self-polishing 
versus rubber cup polishing, in groups of 150 men 
for two years, is in the stage of organization. Like 
our current New London study, it will take about 
four years to obatin statistically valid data. 

At this point we need to recognize the difference 
between younger and older patients. As a whole, 
18-25 year-old men have lesser calculus than older 
patients and, therefore, the self-prophylaxis might 
be sufficient for large numbers of them. This is less 
likely to be satisfactory for older subjects who require 
a true prophylaxis, including subgingival scaling. 
These older men also have increasing need for pre- 
ventive periodontal treatment. Therefore, they 
should receive an annual complete prophylaxis and 
the rubber cup stannous fluoride polishing, rather 
than self -polishing. In my present thinking, the break- 
ing point is probably in the man 25 years of age, 
with the prospect of lowering it to 24, 23, etc., as 
capabilities increase. 

CLINICAL DEVELOPMENT 

Now we might have postponed the Norfolk and 
Great Lakes studies until after the New London 
study was finished. On the contrary, just as our Navy 
built the Polaris in minimal time by researching sev- 
eral phases at the same time, we went ahead and 
set up two paired clinical sites for development — 
that is annual self-prophylaxis in men under 25 and 
rubber cup polishing in men over age 25, with all 
receiving the three agent stannous fluoride treatment. 
Preventive dentistry rooms are constructed. A dental 
technician with audio visual aids presents a lecture 
to up to ten patients at a time on oral hygiene and 
the proven benefits of stannous fluoride. Then he 
demonstrates self-polishing. Then the men apply a 
stannous fluoride polishing to themselves under his 
supervision. Then the topical application is made 
and daily use of a stannous fluoride dentrifice is 
prescribed. The preventive dentistry room has audio- 
visual equipment, rows of wash basins and associat- 
ed accessories for self-polishing, as well as dental 
chairs for topical application — all in a dignified pro- 
fessional atmosphere. 

Again, unwilling to wait several years for the re- 
sults from our four test sites, we have gone ahead 



U.S. NAVY MEDICAL NEWS LETTER 



11 



and instituted the program at one of our naval re- 
cruit centers and at our largest Naval Dental Clinic, 
at Norfolk. This method enables one technician to 
treat fifty patients a day. At a recruit training center, 
600 men can be treated in a day with almost no 
interruption to our 97 dental officers stationed there. 
It can be accomplished the first day the man is in 
the Navy, with no reduction in the routine dental 
treatment load. The benefit and hoped-for inhibition 
of caries begins at once. 

CONCLUSION 

I have not touched on oral hygiene, patient educa- 
tion, fluoridated water supplies, mouth guards for 
athletes, early cancer detection, limited radiation, 
and other aspects of preventive dentistry. Despite 
our interest in all areas of prevention, I have limited 
this discussion to those three basic principles which 
I believe are most directly important to the U.S. 
Navy's Preventive Dentistry Program. 

I believe that the Navy can and will pull up even 
and manage to provide a complete dental service 
for the first time since World War II. The U.S. Naval 
Academy is an outstanding example of the benefits 
of preferential treatment of early lesions. From a 



crash program of repair, a program of too little and 
too late, it has gone to a fastidious and sophisticated 
complete dental service characterized by early treat- 
ment and the need for fewer dental officers. By the 
use of the cement alloy as a holding method in re- 
cruits who present an apparently insurmountable 
work load, we prevent caries lesions from progress- 
ing until we can restore them, Archimedes said, 
"Give me a long enough lever an I can move the 
world." Our present philosophies of preferential 
treatment of early lesions and the cement alloy pro- 
gram can go a long way toward elimination of caries 
in naval personnel. It is just possible that self -polish- 
ing in the three agent stannous fluoride system may 
put the long handle on the lever. 

REFERENCES 

1. Kronfeld, R.: Histopatholgy of the Teeth and their Surrounding 
Structures, Lea and Febiger, Phila., 1939. 

2. Orban, B.: Oral Histology and Embryology, C. V. Mosby Co., 
St. Louis, 1944. 

3. Danele, J. J.: Clinical Evaluation of Indirect Pulp-Capping: 
Progress Report, Abs 320, 39th General Meeting, Internat Ass 
for Dental Research, 1961. 

4. DiMaggio, J, J. and Hawes, R. R. : Continued Evaluation of 
Direct and Indirect Pulp — capping, Abs 22, Proc 41st General 
Meeting, Internat Ass for Dental Research. 1963. 

5. DiMaggio, J. J., Hawes, R. R. and Kiryati, A.: Histological 
Evaluation of Direct and Indirect Pulpcapping, Abs 23, Proc 
41st General Meeting, IADR, 1963. 

6. Scola, F. P., Nielsen, A. G. and Ostrora, C. A.: Clinical Evalu- 
ation of Stannous Fluoride, Progress Report, Abs 339, Proc 41st 
General Meeting, IADR, 1963. 



CLINICAL SIGNIFICANCE OF DEHISCENCE 
AND FENESTRATIONS 

/. Roy Elliott,* DDS MS and Gerald M. Bowers** BS DDS MS. 



Numerous articles have appeared in the literature 
relating to alveolar dehiscence and fenestration 1-9 . 
These anatomical defects of alveolar cortical plate 
are most frequently observed by the periodontist 
during mucogingival surgery; however, they are also 
encountered during oral surgery and endodontic 
procedures when a surgical flap is utilized. The pur- 
pose of this article is to re-emphasize the significance 
of alveolar dehiscence and fenestration and to re- 
view the literature regarding these osseous defects. 

Definition: Alveolar dehiscence denotes the ab- 
sence of alveolar cortical plate resulting in a de- 
nuded root surface while alveolar fenestration is a 
circumscribed defect in the cortical plate exposing 
facial or lingual root surface. These defects are not 
to be confused with osseous deformities of periodon- 
tal disease. In the case of dehiscence and fenestra- 



* Commander, Dental Corps, U.S. Navy: U.S.S. Bryce Canyon 
(AD-36), c/o FPO San Francisco, California.. 
** Lieutenant Commander, Dental Corps, U.S. Navy: Main Naval 
Dispensary, Navy Dept., Wash., D. C. 



tion, a connective tissue covering overlies the os- 
seous lesion and is firmly attached to the root sur- 
face by periosteal fibers 3 . In order to reflect this 
soft tissue covering, considerable pressure is required 
to detach the tissue. In periodontal disease, there 
is pathological pocket formation associated with the 
loss of alveolar bone. 

Etiology: The etiology of alveolar dehiscence and 
fenestration is unknown. Hereditary factors such 
as tooth morphology, size and positioning must be 
considered as possible etiologic factors. The larger 
the roots and the more nearly a tooth approaches 
the periphery of alveolar bone, the more likely the 
occurrence of a bony defect. 

Trauma from occlusion must also be considered 
as an etiological factor, one that has received the 
greatest emphasis in the literature. 

Significance: It has been shown that surgical de- 
fects and recession may result when mucogingival 



12 



U.S. NAVY MEDICAL NEWS LETTER 



surgery is performed on teeth with alveolar de- 
fects 4 -". A thin layer of combined cortical plate-al- 
veolar bone proper often prevents the fenestration 
from occurring as dehiscence. Consequently, bone 
resorption in the region of a fenestration could rea- 
dily produce dehiscence resulting in a postoperative 
defect. Fenestration may actually be a stage in the 
development of dehiscence, a stage enhanced by mu- 
cogingival surgery, oral surgery or apicoectomy. 

Fenestrations of the lingual surface of mandibular 
third molars have been noted 4 . This phenomenon 
may explain the submandibular swelling sometimes 
associated with the abscessed third molar. This os- 
seous defect of the lingual alveolar plate may also 
permit direct access of a root tip or the tooth itself 
into the submandibular space during surgical 
removal. 

Osseous defects of the alveolar plate may present 
a treatment problem when apicoectomy is per- 
formed. Endodontic therapy may fail as a result of 
complete denudation of the root surface following 
a surgical flap procedure on a tooth with a fenestra- 
tion or dehiscence. 

A relationship seems apparent between a narrow 
zone of attached gingiva, high frenum attachment 
and alveolar defects 11 . Teeth that are prominent 
in the arch, such as the mandibular cuspids and 
first premolars, have narrow widths of attached 
gingiva and frequently a resultant high frenum at- 
tachment. There is also a high incidence of alveolar 
defects for prominent teeth or for those that appear 
to be set off basal bone. When this triad is observed 
— narrow width of attached gingiva, high frenum 
or muscle attachments and labially positioned teeth- 
— the clinician should consider the possibility of 
either alveolar dehiscence or fenestration. 

It has been stated that dehiscence is a possible 
contributing factor in gingival recession 12 . It would 
seem logical to assume that alveolar defects also 
contribute to the rapid advance of periodontal 
disease. 

Incidence: A fairly high incidence of defects of 
the cortical plate is reported (2.4% — 60.9% with 
an average of 20.1%). The defects are most com- 
monly observed on the facial surfaces of the maxil- 
lary first molars and anterior teeth with the highest 
incidence occurring on the mandibular cuspid, one 
of the most common sites for mucogingival surgery. 
Fenestrations occur more frequently in the maxilla, 
whereas, dehiscence is predominant in the mandible. 
Both fenestration and dehiscence frequently occur 
bilaterally*- ' . 



Diagnosis: The diagnosis of alveolar defects be- 
comes a clinical problem since the roentgenogram 
is ineffective as a diagnostic tool 4 . Areas of dehis- 
cence are not probable and cannot be palpated". 
As previously discussed, teeth with narrow zones 
of attached gingiva, high frenum attachments and 
gingival recession should be suspected. Until better 
techniques are devised, diagnosis of fenestration and 
dehiscence will depend on experience and clinical 
observation. 

Management: When defects of the alveolar corti- 
cal plate are suspected, it is good surgical procedure 
to avoid reflection of a mucoperiosteal gingival flap. 
This can be accomplished by making the initial inci- 
sion at the mucogingival line or within the alveolar 
mucosa rather than detaching the gingival tissue. 
When this approach is not feasible, sharp dissection 
should be utilized and a fibrous connective tissue 
covering preserved over the cortical plate or root 
surface as the case may be. 

Periodontoplastic procedures which help to avoid 
postoperative defects include the apically reposi- 
tioned flap 10 , the palatal approach to osseous sur- 
gery 8 , periosteal separation 13 and the periosteal fene- 
stration approach 14 . 

Summary and Conclusion: 

1 . A fairly high incidence of cortical plate defects 
has been reported in the literature (average of ap- 
proximately 20% ). 

2. Dehiscence is predominant in the mandibular 
arch; whereas, fenestrations are more commonly ob- 
served in the maxilla. 

3. While dehiscence and fenestrations are not 
regarded as periodontal disease defects, they may 
however contribute to the rapid advance of perio- 
dontal disease. 

4. Surgical procedures exposing the alveolar cor- 
tical bone may be complicated by the presence of 
osseous defects. 

5. Diagnosis of alveolar defects depends on clini- 
cal observation. 

6. Defects were observed most frequently in 
regions where the anatomical shapes and positioning 
of teeth resulted in a thin covering of alveolar bone 
proper and cortical plate. 

7. When this triad is observed, narrow width of 
attached gingiva, high frenum or muscle attachments 
and labially positioned teeth, the clinician should 
consider the possibility of either alveolar dehiscence 
or fenestration. 



U.S. NAVY MEDICAL NEWS LETTER 



13 



BIBLIOGRAPHY 

1. Nabers, C. L., Spears, G. R., and Beckham, L. C, Alveolar 
Dehiscence. Texas Dental Jour 78:4. 1960. 

2. Kakehashi, S., Baer, P. N., and White, C. L., Comparative 
Pathology of Periodontal Disease. I. Gorilla. Oral Surg., Oral 
Med., and Oral Path., 16: 397, 1963. 

3 Stahl, S. S., Cantor, M., and Zwig, E. Fenestration of the Labia! 
Alveolar Plate in Human Skulls. Jour Am Soc Periodontists 
1:99, 1963. 

4. Elliott, J. R., and Bowers, G. M, Alveolar Dehiscence and 
Fenestration. Jour Am Soc Periodontists 1:245, 1963. 

5. Farley, R. A Clinical Study of Dehiscence and Fenestrations, 
Thesis. Ohio State Univ., 1962. 

6. Baer, P. N-, Kakehashi, S., Littleton, N. W„ White, C. L„ and 
Lieberman, J. E. Alveolar Bone Loss and Occlusal Wear. Jour 
Am Soc Periodontists 1:91, 1963. 

7. Bohannan, H. M. The Fixed, Long, Labial, Mucosal Flap in 
Vestibular Alteration. Jour Am Soc Periodontists 1:13, 1963. 

8. Ochsenbein, C. and Bohannan, H. M. The Palatal Approach 
to Osseous Surgery, II. Clinical Application. 35: 54, 1964. 

9. Donnenfeld, O. W., Marks, R. M., and Glickman, I. The Api- 
cally Repositioned Flap — A Clinical Study. Jour Periodontics 
35: 381, 1964. 

10. Friedman, N. Mucogingivai Surgery: The Apically Reposi- 
tioned Flap. Jour Periodontics 33: 328, 1962. 

11. Bowers, G. M. A Study of the Width of Attached Gingiva. 
Jour Periodontics 34: 201, 1963. 

12. Elliott, J. R. Alveolar Dehiscence and Alveolar Fenestration. 
Special Problem in Anatomy Research Report. Ohio State Univ., 
1962. 

13. Corn, H. Periosteal Separation — Its Clinical Significance. Jour 
Periodontics 33: 140, 1962. 

14. Robinson, R. E. Mucogingivai Junction Surgery. Jour Calif 
D A and Nev D Soc 33: 379, 1957. 

SMOKING AND CANCER OF THE MOUTH, 
PHARYNX AND LARYNX 

Condict Moore, MD, JAMA 191(4), 
January 25, 1965 

This is a study of 102 patients that implicates 
tobacco in the carcinogenic process more convinc- 
ingly than previous studies because it approximated 
an ideal planned human experiment, although it was 
actually only an observation of a natural occurrence. 

102 patients were divided into two groups. 
Sixty-five continued smoking after their first mouth/ 
throat cancer. Thirty-seven quit smoking after their 
first mouth/throat cancer. Within approximately six 
years, twenty-one of the sixty-five patients who con- 
tinued smoking acquired a second cancer. Only two 
of the thirty-seven "quitters" developed second can- 
cers in this same period. Such a finding would be 



quite arresting in a laboratory study, but in a human 
study, it is doubly so. 

Although the article points out many other factors 
in relationship to this study, it makes the summary 
that smokers who stop after their first mouth/throat 
cancer run only a small chance of getting another. 
A considerable protection granted by the quitting 
of tobacco in the study indicates that anyone having 
mouth or throat cancer, with a fair prognosis, must 
stop smoking. In those smokers who do get 
mouth /throat cancer, tobacco appears to play a nec- 
essary causative role in 90 percent of them. 

AN IMPROVED SELF-CURING ACRYLIC 
RESTORATION AND COMPARISON WITH 

SILICATE CEMENT RESTORATIONS 

Takae Fusayama, DDS DMSc, Hiroyasu Hosoda, 

DDS DMSc, and Tsugio Iwamoto, DDS DMSc. 

Tokyo Medical and Dental University, Tokoyo, 

Japan. Jour Pros Den 14(3): 537—552. 

Many disadvantages of the self-curing acrylic resin 
restoration have been corrected by an improved tech- 
nique, as presented in this article, of cavity prepara- 
tion, insertion, finishing, and polishing. In a clinical 
test, acrylic resin surpassed the silicate cement in 
the significant qualities of discoloration, surface loss, 
fracture, adaptation, recurrent caries, and pulp inju- 
ry. Marginal adaptation was superior in the silicate 
cement restorations. The present advantages of acryl- 
ic resin broaden the indications for use. The brush- 
on method permits insertion of several restorations 
simultaneously. This study establishes that, although 
acrylic resin does not fulfill all the requirements of 
an ideal restorative material, it offers more advan- 
tages than the silicate cement. 



KNOW YOUR DENTAL CORPS 

(First in a Series) 
U.S. Naval Dental School, Bethesda, Maryland 



The U.S. Naval Dental School is unique — the 
only school of its kind in the world. Unlike most 
dental institutions, which provide instruction in den- 
tistry at the undergraduate and graduate level, this 
School is devoted wholly to advanced education for 
both dentists and their assistants. Its purpose is to 
improve the practice of dentistry by educating pro- 
fessional men in the most modern scientific tech- 
niques; also, to train auxiliary personnel in effective 



assistance procedures. Career dental officers there- 
fore study the latest advances in the basic sciences 
allied to clinical dentistry, as well as acquainting 
themselves with the latest materials, methods, and 
equipment related to patient' care. Similarly, dental 
technicians receive advanced training in dental as- 
sisting, accounting, personnel management, equip- 
ment repair, and laboratory technics. 

The School was established in 1922 by Surgeon 



14 



U.S. NAVY MEDICAL NEWS LETTER 



General E. R. Stitt as the Department of Dentistry 
of the U.S. Naval Medical School, in Washington, 
D.C., where the Bureau of Medicine and Surgery 
is now located. The first class of five dental officers 
was convened on February 3, 1923, for a nineteen 
weeks' course of postgraduate instruction in Naval 
Dental Medicine. Coincidental with the convening 
of the dental officers' course, the first group of 10 
hospital corpsmen began a course designed to qual- 
ify them to assist dental officers, to perform oral 
prophylaxis procedures, and to fabricate various 
prosthetic appliances. Instruction in these latter 
procedures was required to support the newly author- 
ized prosthetic service which was introduced at the 
Dental School. 

After being inactivated from 1932 to 1935, the 
School was re-established as a separate command 
on March 17, 1936. Since that time it has gradually 
increased its enrollment and extended its functions 
to meet the changing needs of the service. On Feb- 
ruary 6, 1942, the School became a component 
command of the newly constructed National Naval 
Medical Center, in Bethesda, Maryland. Originally, 
it occupied only the north wing of the Center, but 
within a few years its rapid growth forced it to ex- 
pand most of its scholastic functions into a tempo- 
rary three-story barracks-type building, which it still 
occupies. 

From its inception, the Naval Dental School has 
had but little change in its threefold mission. Cur- 
rently stated, this is: to conduct postgraduate and 
advanced instruction for Dental Corps officers in the 
various fields of dentistry peculiar to the needs of 
the naval service; to instruct and train enlisted per- 
sonnel to perform duties of dental ratings; and to 
provide dental support to other activities of the Na- 
tional Naval Medical Center. 

Under its Commanding Officer, the U.S. Naval 
Dental School is organized into nine departments. 
Five of these are clinical: Oral Diagnosis, Periodon- 
tics, Operative Dentistry, Oral Surgery, and Prostho- 
dontics. The other four are educational: Officer 
Education, Enlisted Education, Audiovisual, and 
Publications. However, the officers of the clinical 
departments have a vital part in the educational pro- 
grams, and there is a free flow of ideas and infor- 
mation between all staff members. There is also 
a free exchange of teaching talent and laboratory 
facilities among all units of the Center. 

The core of the officer education program is the 
Graduate Course for dental officers who usually have 
about 5 to 8 years of service in the Regular Navy 
at the time of their selection for instruction. In this 



intensive 10-month program, divided between class- 
room, clinic, and laboratory, 28 dental officer stu- 
dents learn the latest advances in the basic sciences, 
as well as in clinical dentistry and research. The 
courses are conducted by experienced naval and civil- 
ian instructors, many of whom are diplomats of 
the dental specialty boards. Several Naval Dental 
School officers having appointments to the staff of 
the Graduate School of Georgetown University, as 
well as regular instructors of the University, conduct 
certain lectures and laboratory sessions which permit 
students to receive 1 2 hours of credit toward a Mas- 
ter of Science degree at Georgetown University. 

Each year, approximately eight dental officers are 
assigned to the Dental School for residency instruc- 
tion in Periodontics, Prosthodontics, Oral Surgery, 
Oral Pathology, Endodontics, and Oral Medicine. 
In addition to the Graduate Course and the residen- 
cies, the Officer Education Department annually of- 
fers 11 one-week courses in the dental specialties. 
These are open to all dental officers of the Armed 
Forces and other Federal Agencies. 

The Enlisted Education Department conducts 6- 
month advanced courses for general and prosthetic 
dental technicians and a basic course for dental 
repairmen. 

The Audiovisual Department develops plans for 
motion pictures, television programs, videotapes, 
and scientific exhibits on subjects ranging from oral 
hygiene to complex professional procedures, and 
provides technical assistance in their production. 
The Department also prepares slide-illustrated lec- 
tures, table clinics, and functional training aids for 
Navy-wide use. 

The Publications Department prepares and pub- 
lishes professional, technical, and informational ma- 
terials for the School and for the entire U.S. Naval 
Dental Corps. The best known of these are the pro- 
fessional correspondence courses for dental officers 
and the three handbooks for dental technicians. 
Correspondence courses in dental subjects are avail- 
able only in the education program of the U.S. 
Naval Dental Corps; therefore, the Publications 
Department administers these courses for all Regular 
and Reserve dental officers of the Armed Forces 
and other Federal agencies. 

Clinical services range widely from basic instruc- 
tion in preventive dentistry to extensive dental reha- 
bilitation and complex facial surgery. These services 
also include histopathological examination of speci- 
mens for all naval dental facilities. The clinical serv- 
ices are supported by such research as the investi- 



U.S. NAVY MEDICAL NEWS LETTER 



15 



gation of drugs to make treatment easier and more 
effective, and the improvement of equipment and 
technics for more efficient and comfortable 
treatment. 



Through its educational, clinical, and research 
programs, the Naval Dental School contributes in 
many ways toward the improved oral health of naval 
and Marine Corps personnel throughout the world. 



PERSONNEL AND PROFESSIONAL NOTES 



Dental Officer Presentations. CAPT Frank J. Kra- 
tochvil Jr. DC USN, U.S. Naval Dental School, 
NNMC, Bethesda, Maryland, presented an illus- 
trated lecture, entitled, "Anatomy of Temporo-Man- 
dibular Joint as it Effects Occlusion," before the 
Dental Science Club on 23 February 1965 in Wash- 
ington, D.C. 

LCDR William K. Bottomley DC USN, U.S. Na- 
val Dental School, NNMC, Bethesda, Maryland, pre- 
sented a lecture, entitled, "Problems in the Treat- 
ment of the Herpes Simplex-Like Syndrome," before 
the Washington Section of the International Associa- 
tion for Dental Research on 1 March 1965 in Be- 
thesda, Maryland. 

LCDR James E. Klima DC USN, U.S. Naval 
Training Center, Great Lakes, Illinois, presented an 
illustrated lecture, entitled, "The Preventive Den- 
tistry Program at the Great Lakes Naval Training 
Center," before the Wisconsin Special Service Den- 
tists and staff on 28 January 1965 at the Winnebago 
State Hospital, Winnebago, Wisconsin. 

CAPT Philip J. Boyne DC USN, USS Bon 
Homme Richard CVA-31 presented a lecture, enti- 
tled, "A Study of Osseous Healing Following Osteot- 
omy for the Correction of Mandibular Progna- 
thism," before the Dental Staff of the U.S. Naval 
Hospital, San Diego, California on 22 January 1965. 

CAPT Boynes lecture was. the same paper which 
won the Research Award of the Year by the Ameri- 
can Society of Oral Surgeons at Las Vegas, Nevada 
in -November 1964. 

LT Charles L. Stoup DC USN, U.S. Naval Hos- 
pital, Chelsea, Massachusetts, presented a clinical 
demonstration, entitled, "The Necessity for Correc- 
tion of Laboratory and Restoration Errors in Com- 
plete Denture Construction," before the Massachu- 
setts Dental Society on 18 January 1965 in Boston, 
Massachusetts. 

LT Robert A. Lawton DC USN, U.S. Naval 
Hospital, Chelsea, Massachusetts, presented a lec- 
ture, entitled, "A Technic for the Construction of 
Post Crowns for Posterior Teeth," before the Massa- 
chusetts Dental Society on 3 8 January 1965 in 
Boston, Massachusetts. 



Assignment of Personnel to Dental Technicians 
School, Class "A". BUPERS has advised the Dental 
Division that the planned input for the Class "A" 
school in fiscal years 1966 and 1967 will be 274 
students as opposed to the 648 in fiscal year 1965. 

Due to this reduction, the number of "strikers" 
to be ordered to the school will be reduced. Only 
personnel who meet all eligibility requirements spec- 
ified in BUMEDINST 1510.6B should be utilized 
as strikers and/or recommended for school. 

A critical shortage of personnel in the AN and 
TN rates exists. Men in those rates should not be 
utilized as strikers as it is extremely unlikely they 
will be authorized to attend Dental Technicians 
School. 

Armed Forces Desert Dental Society Meeting. CAPT 
Harry B. Mclnnis DC USN, Dental Officer, U.S. 
Marine Corps Air Station, El Toro, Santa Ana, Cali- 
fornia hosted a meeting of the Armed Forces Desert 
Dental Society on 22 January 1965 at Norton Air 
Force Base, San Bernardino, California. Fifty-one 
members and guests attended the meeting from 
twenty-seven activities located throughout the far- 
thest reaches of the ELEVENTH Naval District. 

CAPT Mclnnis is a charter member of the Armed 
Forces Desert Dental Society. He joined the group, 
which formed from a nucleus of five activities, in 
1951 when he was stationed at Barstow, California. 

CAPT Perry C. Alexander DC USN, U.S. Naval 
Dental Clinic, Long Beach, California, presented a 
lecture, entitled, "Movements of the Condyle." 

Navy Dentist Elected President of CZ Dental Soci- 
ety. The 35th Annual Panama Canal Zone Dental 
Society Meeting was held 6 February 1965 at 
Albrook Air Force Base, Canal Zone. The meeting 
was honored by the participation of a number of 
distinguished dentists, including Dr. Fritz A. Pier- 
son, President of the American Dental Association. 
Dr. Pierson discussed several interesting activities 
of the ADA including: the continuous efforts to as- 
sist exiled Cuban dentists to practice in the United 
States; the support of Project USS Hope; and the 



16 



U.S. NAVY MEDICAL NEWS LETTER 



Association's support of the Institute of Internation- 
al Education, a private non-profit organization that 
administers many United States grants to foreign 
dental graduate students. 

The meeting, moderated by LCOL H. J. Lord 
Jr. DC USAF, was held in the simultaneous transla- 
tion facility of the USAF School for Latin America 
to accommodate the Panamanian representatives. 

CAPT S. Robert Howell DC USN, 15 ND Dental 
Officer, was elected President of the Canal Zone 
Dental Society for the ensuing term. 

Sub Base Dentists Assist County Dentists in Nation- 
al Children's Health Week. Eleven Navy Dental 
Officers of the U.S. Naval Submarine Base, New 
London, assisted the New London County Dental 
Association in promoting National Children's Dental 
Health Week, February 7-13. The theme for this 
year was "Heal Their Teeth — Happy Life." 
Equipped with a movie on Oral Hygiene, large mod- 
els of teeth and toothbrushes, and pamphlets, enti- 
tled, "I must Brush My Teeth," these officers visited 
eleven schools in the New London-Groton area dur- 
ing the week for a series of lectures on the impor- 
tance of dental health. 

The talks emphasized the importance of proper 



nutrition and oral hygiene in the preservation of 
Dental Health. The lectures were arranged by Dr. 
Vincent F. Masin of the New London County Dental 
Association, Miss Ann Cowhey of the New London 
Department of Health and CAPT George O. Stead, 
Senior Dental Officer at the Base. 

Charleston Military-Civilian Dental Meeting. CAPT 
William Seidel DC USN, SIXTH Naval District 
Dental Officer recently announced that Navy Dental 
Officers hosted a meeting of seventy-five Armed 
Forces and civilian dentists in the Charleston area. 
The meeting was held at the Naval Base, Charleston, 
and featured several clinics in addition to a showing 
of the Navy film Periodontal Disease — Prevention 
and Early Treatment. The clinicians and their pres- 
entations were: CAPT A. L. Raphael DC USN, 
Naval Station, "Amalgam Splints for Periodontally 
Involved Teeth," CDR F. M. Amman DC USN, 
USS Howard W. Gilmore (AS-16), "An Altered 
Cast Technique for Posterior Extension Partial Den- 
tures," CDR F. A. Marmarose DC USN, USS Ever- 
galdes (AD-24), "A Practical and Economical 
Method of Converting Dental Operating Chairs to 
Modern Contour Type," LCDR C. G. Strange DC 
USN, Naval Station, "The Dowel Abutment Crown." 



PREVENTIVE MEDICINE 

INFLUENZA AND INFLUENZA-LIKE ILLNESS 

DHEW PHS Morbid & Mortal Wkly Rpt CDC Atlanta, Ga., 14(5): 41-42 & 45; 
14(6): 53-55; and 14(8): 73-74, February 6, 13, and 27, 1965. 



UNITED STATES: Since early January 1965, 
Group A influenza infections have been confirmed 
by laboratory methods in the following states: New 
England States, Pennsylvania, Missouri, Iowa, Mich- 
igan, Alabama, Kansas, Illinois (Chicago), and 
Georgia (Atlanta). Unconfirmed, but clinically sus- 
pect, outbreaks of influenza-like illness have been 
reported from Maine and Mississippi. 

At present, A 2 influenza virus isolates have been 
recovered in New York, New Jersey, Connecticut, 
Pennsylvania, Missouri, Kansas, Michigan, Georgia 



(Atlanta), and Illinois (Chicago). All geographic 
areas, with exception of New England States, are 
well below the epidemic threshold. The new Eng- 
land States continue to have excess mortality at 
the same levels previously reported; Middle Atlantic 
States are within normal limits. 

NEW YORK: Upper respiratory illness has been 
prevalent throughout the State during the past 
weeks. Three A H influenza viruses have been iso- 
lated from sporadic cases during mid-January in 2 

counties. 



U.S. NAVY MEDICAL NEWS LETTER 



17 



VERMONT: Since mid-January, outbreaks of 
acute febrile respiratory disease with systemic symp- 
toms have been noticed in 3 counties. Serologic con- 
firmation of influenza A has been reported from 2 
counties. Virus silation attempts are in process. 

NEW HAMPSHIRE: The scattered outbreaks of 
influenza-like illness in New Hampshire have now 
been serologically confirmed as type A influenza. 

MISSOURI: A, influenza has been identified in 
2 patients in Princeton, Missouri, by hem agglutina- 
tion-inhibition tests. 

MISSISSIPPI: A focal outbreak of acute febrile 
respiratory disease occurred in the rural area of 
Rankin County on January 25, characterized by rap- 
id onset, fever, chills, headache, arthralgias and 
upper respiratory symptoms. The first appearance 
of disease was in school age children (15 to 20%) 
with secondary cases in families being observed. Ser- 
ologic confirmation of this outbreak is in process. 

ALABAMA: A recent outbreak of widespread 
influenza, particularly affecting younger age groups, 
was reported during the 2nd week of February 1965 
from Clarke County; the southern portion was most 
heavily involved. Adults were affected with an in- 
creased number of cases of pneumonia being re- 
ported. A serological survey carried out on unpaired 
acute and convalescent sera specimens demonstrated 
significantly increased levels of HI antibodies to type 
A influenza during the convalescent phase. Virus 
isolation attempts are underway. 

IOWA: In mid-February, Type A influenza was 
serologically confirmed. Some 3 weeks ago, an 
abrupt outbreak of acute febrile respiratory disease 
developed in a small town in southeastern Iowa. 
A major proportion of the cases occurred among 
students attending a liberal arts college in the com- 
munity, many of whom had returned only recently 
from visits in various parts of the East. Paired sera 
specimens from 2 cases demonstrated a rise in HI 
titer to influenza type A. 

MICHIGAN: There has been a general increase 
in acute febrile respiratory disease during the past 
months, particularly in the Grand Rapids, Monroe, 
Lansing and Ann Arbor regions. Illnesses have been 
mainly in school children because of "spotty" school 
absenteeism. An A 2 influenza virus antigenically sim- 
ilar to A^/Taiwan/64 has been isolated from a 
student where increased numbers of influenza-like 



illnesses have been observed in the first week of 
February. 

KANSAS: Influenza-like illness has been ob- 
served in 5 counties so far this winter. In 2 counties 
the illness has been confirmed as influenza type A 
by CF test. A 2 virus has been isolated by the CDC 
Laboratory, Kansas City Field Station, from a lung 
tissue of a fatal case of pneumonia occurring in 
Kansas City. 

GEORGIA: Georgia, previously unreported, has 
experienced a widespread occurrence of febrile dis- 
ease much of it being respiratory during February. 
There has been serological confirmation of type A 
influenza and presumptive virus isolation of type A^ 
influenza in several areas of Atlanta, Georgia, in 
mid-February. 

ILLINOIS: Type A a influenza viruses have re- 
cently been isolated from several university students 
in the Chicago area. 

COLORADO: Scattered occurrence of influen- 
za-like illness has been observed in Colorado, partic- 
ularly the Denver area, since mid-February. Virus 
isolation and serological confirmation of type B in- 
fluenza was obtained from one Denver outbreak. 

EASTERN GERMANY (January 1965): The 
World Health Regional Virus Reference Laboratory, 
Prague, Czechoslovakia, has reported by telephone 
to the WHO that outbreaks of influenza-like illness 
occurred in January in Eastern Germany, mainly in 
the northern part towards the Baltic coast. Serologi- 
cal evidence of infection with virus A 2 , from scat- 
tered outbreaks, have been obtained and 4 strains 
of virus A 2 have been isolated by laboratories in 
Eastern Germany. 

FRANCE (25 Jan 1965): Serological evidence of 
infection with virus A-, was obtained in Paris and 
environs, as well as in the east, west and center of 
the country. Serological evidence of infection with 
virus B was obtained in Paris and its suburbs, and 
in the Northeast of the country (Aisne Department). 

USSR (29 Jan 1965): Outbreaks of influenza were 
reported by telephone to the World Health Organi- 
zation by the WHO Virus Reference Center in Mos- 
cow. Preliminary reports from Moscow indicated 
that an epidemic began in Leningrad about 9 Jan- 
uary 1965, reached its peak about 18 January and 
is now declining. Thousands of cases, many in chil- 
dren, occurred but the incidence was less than in 



18 



U.S. NAVY MEDICAL NEWS LETTER 



the epidemic there 3 years ago. The disease was 
not severe. 

A sharp increase in influenza-like illness has been 
reported from Arkhangelisk in the North, Khaba- 
rovsk in the East, and from Tallin, Riga, and 
Moscow. 

Influenza virus A 2 was isolated from cases in 
Leningrad and Moscow. Primary isolations were 
made with some difficulty. Strains have been sent 
to the 2 International Influenza Centers, London and 
Atlanta for further study (identified as A,/Singa- 
pore/1957). 

Since December 1964, about 4 million people in 
the USSR have been vaccinated with live influenza 
vaccine. Because of the low incidence of influenza 
in the past 2 or 3 years in the USSR, it was thought 
that an epidemic might occur this year and clinics 
and hospitals increased their supplies of antibiotics 
and other drugs as a precaution. 

JAPAN (Feb): Sporadic outbreaks of influenza- 
like illness are being reported. A strain of influenza 
virus A 2 has been isolated from a case in a Tokyo 
suburb. 

RUBELLA IN CONTACTS OF INFANTS WITH 
RUBELLA-ASSOCIATED ANOMALIES 

DHEW PHS Morbid and Mortal Wkly Rpt, CDC 
Atlanta, Ga., 14(5): 44-45, Feb 6, 1965. 

Nine cases of rubella among medical personnel 
caring for infants with rubella-associated anomalies 
have been documented. A large proportion of chil- 
dren with rubella-associated anomalies excrete ru- 
bella virus, sometimes for long periods following 
birth, indicating that the risk of acquired infection 
from these children may be high. 

A group at the New York University School of 
Medicine has studied more than 100 infants with 
congenital defects thought to be caused by rubella 
infection acquired in utero. An interfering agent 
with properties characteristic of rubella virus has 
been isolated from throat swabs, urine specimens 
and/or rectal swabs obtained from 60-70% of these 
patients. Although the well-recognized "classical" 
defects such as congenital heart disease and cataracts 
have been seen most frequently, more obscure con- 
ditions such as thrombocytopenic purpura and/or 
splenomegaly without any detectable anomaly have 
also been associated with viral excretion. 

Questioning nursery and pediatric ward personnel 
who cared for these infants at hospitals throughout 
New York City, the authors encountered 8 nurses 



and 1 resident physician who had developed an ill- 
ness typical of rubella with an onset of symptoms 
approximately 2 to 3 weeks after close and pro- 
longed physical contact with these babies. Significant 
is the fact that certain of the infants excreted virus 
for months. For example, the defective infant was 
almost 9 months old at the time of contact in case 
3. 

Case 1. Bar., a 30-year-old married nurse, was 
exposed to many pregnant patients with rubella in 
the Spring of 1964 while working in the Obstetrics 
Clinic. In August 1964, she was transferred to the 
Premature Nursery. On 23 Nov 1964, she admitted 
a newborn infant with typical rubella- associated de- 
fects and cared for this infant daily thereafter. On 
16 Dec 1964, she developed typical rubella mani- 
fested by a maculopapular rash, occipital, postauric- 
ular, cervical, auxiliary and inguinal adenopathy, 
and low grade fever. The diagnosis was confirmed 
by isolation of virus from her throat swab on the 
3rd day of rash. Rubella virus had previously been 
detected in throat and rectal swabs obtained from the 
infant. 

Case 4. Dow., a 33-year-old single nurse, cared 
for a newborn infant with severe rubella embryo- 
pathy on 25 and 26 Oct 1964, prior to leaving for 
vacation. On 16 Nov, while still on vacation, she 
developed rubella characterized by a rash which per- 
sisted for 3 days, occipital and postauricular lymph 
adenopathy, and painful swelling of her interpha- 
langeal joints and wrists. The arthritis cleared after 
48 hours. Her roommate, a nurse who worked in 
another unit at the same hospital, developed a simi- 
lar illness with rash, adenopathy and joint manifesta- 
tions 14 to 16 days later. The newborn infant was 
shown to be excreting rubella virus in throat swab 
and urine specimens. 

Case 8. Sha., a 28-year-old pediatric resident, was 
exposed on 10 Nov 1964, to a 1 -month old infant 
with "rubella syndrome," characterized by congeni- 
tal heart disease and cataracts. He examined this 
infant regularly until 29 Nov, when he developed 
rubella manifested by rash, adenopathy and back 
pain. Sixteen days later, his wife and child also devel- 
oped typical rubella. The defective infant was still 
a virus-excretor when last studied at the age of 2Vi 
months. No attempt was made to isolate virus from 
the pediatric resident or his family. 

Two features common to the 9 cases described 
provide strong circumstantial evidence implicating 
these virus-excreting infants as the source of rubella 



U.S. NAVY MEDICAL NEWS LETTER 



19 



infection. One is the incubation period, an appro- 
priate 2 to 3 weeks after intimate contact. The sec- 
ond is the low incidence of rubella in the general 
community at the present time. 

In view of these observations, it is recommended 
that infants born with rubella-associated anomalies 



be managed with the same precautions employed 
for patients with rubella. It obviously is most impor- 
tant for women in the first trimester of pregnancy 
to avoid exposure to these infants. 
(Louis Z. Cooper, M.D., et. al, Depts Med & Ped., 
New Yord Univ School Med., New York.) 



HOSPITAL PERSONNEL DEVELOPING RUBELLA AFTER CARING FOR 
INFANTS WITH "RUBELLA SYNDROME" 



Name 

1. Bar* 

2. Col. 

3. Dav. 

4. Dow. 

Edw. 

Fie. 

Gre. 

Sha. 

Woi.* 



Occupation Age 



Sex 



Time of Intimate Contact with Time of Onset 

Possible Virus-Excreting Infants of Rash 



5. 
6. 

7. 



Nurse 

Nurse 

Nurse 

Nurse 

Nurse 

Nurse 

Nurse 

Physician 

Nurse 



30 
21 
20 
33 
26 
21 
23 
28 
26 



F November 23 — December 15 December 16 

F December 7 — December 24 December 25 

F September 10 — October 29 November 2 

F October 25 — October 26 November 9 

F October 25 — December 4 December 5 

F August 22 — November 5 November 6 

F December 18 — January 8 January 9 

M November 10 — November 28 November 29 

F December 15 — January 10** January 18 



•Rubella virus isolated from throat swab at time of illness. . . „„„„„„„„ 

** Infant with multiple, classical rubella anomalies and history of maternal rubella during first trimester or pregnancy. 



SHELLFISH-ASSOCIATED HEPATITIS 

CDC Hepatitis Surveillance Rpt 21, Pg 25-27, 

December 31, 1964. 

All 4 of the known epidemics of infectious hepa- 
titis associated with the ingestion of raw shellfish 
from commercial sources have begun in late fall. 
The month of peak incidence was January in 3 of 
these, and March in the fourth. In view of this sea- 
sonal pattern persons responsible for hepatitis sur- 
veillance on a state or local basis should intensify 
efforts to detect shellfish-associated epidemics at this 
time of year. The smallest epidemic to have been 
described accounted for 84' cases related to the 
ingestion of raw oysters from Pascagoula, Mississip- 
pi 1 . All 3 of the clam-associated epidemics involved 
over 100 cases each *•*»♦. With improved tech- 
niques for detection, it should be possible to uncover 
smaller outbreaks, and, by means of prompt reme- 
dial action, bring about a reduction in hepatitis mor- 
bidity. It seems worthwhile, therefore, to review 
some of the epidemiological indices which may serve 
as "warning signals" for the presence of such 
epidemics. 

I. Age and Sex Distribution. A shift in the age 
distribution of reported hepatitis cases toward a 
greater proportion of adults was a clue to one epi- 
demic of the past. Analysis of the age and sex distri- 
bution in known shellfish-associated epidemics has 
shown a preponderance of young adult males. While 



age and sex data are worth monitoring because they 
are almost always available on a routine basis, they 
are, unfortunately, insensitive indicators. They are 
likely to reflect only epidemics of major proportions. 

2. Socioeconomic Pattern. While raw clams and 
oysters are consumed to a varying extent in different 
areas of the United States, such raw shellfish inges- 
tion is often a middle and upper-class phenomenon. 
The appearance of a number of such cases, there- 
fore, should alert health authorities to the possibility 
of a shellfish-related epidemic. 

3. History of Personal Contact. A question con- 
cerning contact with a known case of hepatitis 
during the 2 months prior to onset is often included 
on surveillance forms used by state and local health 
departments. An analysis of 7907 forms submitted 
to CDC for cases diagnosed as infectious hepatitis 
with onsets during epidemiological year 1963-64 is 
in Table 1. The responses to the question about 
personal contact were tabulated separately for pa- 
tients who denied raw shellfish ingestion and those 
who had eaten raw clams or oysters during the two 
months prior to onset. 

4. History of Raw Shellfish Ingestion. A question 
about raw shellfish ingestion should be a part of 
the epidemiological history obtained on adult cases. 
The question should specifically relate to raw clams 
or raw oysters during the two months prior to onset. 



20 



U.S. NAVY MEDICAL NEWS LETTER 



There is no evidence that other forms of shellfish, 
such as shrimp and lobster are related to hepatitis. 
Provided the cooking process is adequate, there is 
also no need to obtain information about cooked 
shellfish. The results of questions relating to the gen- 
eral habit of shellfish ingestion or to periods of 
greater than 2 months are difficult to interpret. If 
a hepatitis patient admits raw shellfish consumption 
on the preceding 2 months, detailed information as 



to the time(s) and place (s) of eating should be 
sought. In this way it may be possible to link several 
cases to a single source of supply, and thus raise 
the suspicion of a common source epidemic. If a 
routine tabulation of hepatitis surveillance data 
shows that more than 10% of adult cases give a 
history of raw clam or oyster ingestion, the suspicion 
of health authorities should be aroused. If the per- 
centage exceeds 15, an investigation should begin. 



TABLE I 



Age Group 



Shellfish Negative 

Number of Percent with 

Cases Personal Contact 



Shellfish Positive 

Number of Percent with 

Cases Personal Contact 



0-19 
20-39 
40 & over 
Total 



3374 
2913 
1083 
7370 



31.8% 
20.6% 
10.3% 

24.2% 



62 
335 
140 
537* 



17.7% 
6.3% 
8.5% 
8.2% 



• Includes cases from the 1964 clam-associated epidemic in Southern New Jersey and Greater Philadelphia area. 



In all but the oldest age group a smaller percent- 
age of shellfish-positive cases reported contact with 
a known case of hepatitis. Thus, if the proportion 
of cases with a history of personal contact is signifi- 
cantly lower than that shown above for "shellfish-neg- 
ative" cases, the presence of an epidemic related 
to a common source mode of spread, possibly raw 
shellfish, should be suspected. 



REFERENCES 



1 Mason, J. O., and McLean, W. R.: Infectious Hepatitis Traced 
to the Consumption of Raw Oysters. Amer Jour Hyg 75: 90-111, 
1962. 

2 Dougherty, W. J. and Attman, R.: Viral Hepatitis in New 
Jersey, 1960-61. Amer Jour Med 32: 704-736, 1962. 

3. U.S. Communicable Disease Center, Hepatitis Surveillance Report 
No. 18, March 31, 1964. 

4. U S. Communicable Disease Center, Hepatitis Surveillance Re- 
port No. 19, June 30, 1964. 

DECLARATION OF HELSINKI 

WHO Chronicle, WHO 19: 1, "Declaration of 

Helsinki. Recommendations Guiding Doctors in 

Clinical Research." January 1965. 

Introduction 

It is the mission of the doctor to safeguard the 
health of the people. His knowledge and conscience 
are dedicated to the fulfillment of this mission. 

The Declaration of Geneva of the World Medical 
Association binds the doctor with the words: "The 
health of my patient will be my first consideration" 
and the International Code of Medical Ethics de- 
clares that "Any act or advice which could weaken 



physical or mental resistance of a human being may 
be used only in his interest." 

Because it is essential that the results of labora- 
tory experiments be applied to human beings to 
further scientific knowledge and to help suffering 
humanity, the World Medical Association has 
prepared the following recommendations as a guide 
to each doctor in clinical research. It must be 
stressed that the standards as drafted are only a 
guide to physicians all over the world. Doctors are 
not relieved from criminal, civil and ethical responsi- 
bilities under the laws of their own countries. 

In the field of clinical research a fundamental dis- 
tinction must be recognized between clinical research 
in which the aim is essentially therapeutic for a pa- 
tient, and the clinical research, the essential object 
of which is purely scientific and without therapeutic 
value to the person subjected to the research. 

Basic Principles 

Clinical research must conform to the moral and 
scientific principles that justify medical research and 
should be based on laboratory and animal experi- 
ments or other scientifically established facts. 

Clinical research should be conducted only by 
scientifically qualified persons and under the supervi- 
sion of a qualified medical man. 

Clinical research cannot legitimately be carried 
out unless the importance of the objective is in pro- 
portion to the inherent risk to the subject. 



U.S. NAVY MEDICAL NEWS LETTER 



21 



Every clinical research project should be preceded 
by careful assessment of inherent risks in compari- 
son to foreseeable benefits to the subject or to 
others. 

Special caution should be exercised by the doctor 
in performing clinical research in which the person- 
ality of the subject is liable to be altered by drugs 
or experimental procedure. 

Clinical Research Combined with Professional Care 

In the treatment of the sick person, the doctor 
must be free to use a new therapeutic measure, if 
in his judgment it offers hope of saving life, re-estab- 
lishing health, or alleviating suffering. 

If at all possible, consistent with patient psycholo- 
gy, the doctor should obtain the patient's freely given 
consent after the patient has been given a full 
explanation. In case of legal incapacity, consent 
should also be procured from the legal guardian; 
in case of physical incapacity, the permission of the 
legal guardian replaces that of the patient. 

The doctor can combine clinical research with 
professional care, the objective being the acquisition 
of new medical knowledge, only to the extent that 
clinical research is justified by its therapeutic value 
for the patient. 

Non-therapeutic Clinical Research 

In the purely scientific application of clinical re- 
search carried out on a human being, it is the duty 
of the doctor to remain the protector of the life 
and health of that person on whom clinical research 
is being carried out. 

The nature, the purpose and the risk of clinical 
research must be explained to the subject by the 
doctor. 

Clinical research on a human being cannot be 
undertaken without his free consent after he has 
been informed; if he is legally incompetent, the con- 
sent of the legal guardian should be procured. 

The subject of clinical research should be in such 
a mental, physical and legal state as to be able to 
exercise fully his power of choice. 

Consent should, as a rule, be obtained in writing. 
However, the responsibility for clinical research al- 
ways remains with the research worker; it never falls 
on the subject even after consent is obtained. 

The investigator must respect the right of each 
individual to safeguard his personal integrity, espe- 
cially if the subject is in a dependent relationship 
to the investigator. 



At any time during the course of clinical research 
the subject or his guardian should be free to with- 
draw permission for research to be continued. 

The investigator or the investigating team should 
discontinue the research if, in his or their judgment, 
it may, if continued, be harmful to the individual. 

ANTIMICROBIAL PROPHYLAXIS FOR INDI- 
VIDUALS WITH 
A HISTORY OF RHEUMATIC FEVER 

The prevention of streptococcal infection in indi- 
viduals who have had rheumatic fever is duscussed 
in the Naval Medical Publication entitled, "Treat- 
ment and Prevention of Streptococcal Disease and its 
Sequelae" (NAVMED P-5052-17), which is cur- 
rently under revision. A portion of paragraph 7, 
which will remain unchanged in the revised edition, 
states: 

"The Commission of Streptococcal Disease of the 
Armed Forces Epidemiological Board has recom- 
mended that individuals who have had rheumatic 
fever, as indicated by a valid history of rheumatic 
fever, or the presence of rheumatic heart disease, 
receive continuous antimicrobial prophylasis. Opin- 
ion varies on the length of time to continue prophy- 
laxis after the last attack of rheumatic fever, but 
five years is probably a minimum. Evidence of heart 
damage, duty in high exposure environment and age 
under 40 years may indicate extension of this time." 

Recruit training, service school training, sea duty, 
and, indeed, any situation in which men are forced 
into intimate living conditions, should be considered 
a high exposure environment. 

— Communicable Disease Branch, PrevMedDiv. 

LEECH REPELLENT 

Some confusion evidently still exists concerning 
the use of repellents for personal protection from 
bites due to mosquitoes, black flies, deer flies, fleas, 
ticks, chiggers, and leeches. The standard military 
repellent deet, FSN 6840-753-4963, supplied in 2 
ounce polyethylene bottles, is effective to varying 
degrees against all of the above pests. Furthermore, 
it is the most effective repellent available for most 
of these pests. See BUMED INSTRUCTION 
6250.10 for further details. 

In regard to leeches, both land and aquatic 
leeches may be encountered in certain tropical or 
sub-tropical areas of the world. Deet is effective, as 
mentioned above; however, land leeches are usually 
found only where the climate is warm and damp. 



22 



U.S. NAVY MEDICAL NEWS LETTER 



Therefore, deet applied to skin and clothing may 
be removed by brushing against wet vegetation, or 
by excessive sweating, requiring frequent reapplica- 
tions of the repellent. Aquatic leeches present a 
more serious problem, because deet is washed off 
in water. An aquatic leech repellent consisting 
of a 25% deet — 75% lanolin mixture has been de- 
veloped for special military uses; the lanolin content 
resists wash-off. This mixture is not a standard stock 
item, however. 

Deet is the recognized common name of the chem- 



ical diethyltoluamide. FSN 6840-753-4963 consists 
of 75% deet and 25% denatured ethanol. Deet also 
is the active ingredient in the better commercial 
repellents, usually in 15 to 50% strengths; the stand- 
ard military item is a better repellent because pro- 
tection time agaist biting insects, ticks, etc., is deter- 
mined by the actual amount of deet present on skin 
or clothing. For this reason, the deet-lanolin aquatic 
leech repellent is effective on dry skin only for about 
Vz of the time that standard military deet is effective. 
— Vector Control Section, PrevMedDiv. 



KNOW YOUR WORLD 



DID YOU KNOW: 



That a flock of geese are the latest participants 
in Florida's efforts to control water weeds without 
chemicals? 

The geese are clipping away at weeds along the 
lagoon banks of the Margate Sewage Treatment 
Plant's polishing pond. In Broward County, Florida, 
sea cows are being imported to clean up ponds and 
keep aquatic weeds under control. 

No report is available as yet on the progress the 
British are making with the 15,000 carp they im- 
ported from Hong Kong to gobble up the weeds 
which clog the water inlets of a large power station 
on the Irish Sea coast in Lancashire. ( 1 ) 



That poor design of ponds cause disease? 

Recent outbreaks of encephalitis throughout the 
nation have focused attention on the need for rigid 
design control of small water-retention structures. 
A water management researcher from Georgia told 
a meeting of the American Society of Agricultural 
Engineers that farm ponds and small reservoirs de- 
signed to retard flood waters are ideal breeding 
grounds for disease-carrying mosquitoes and that a 
study of the mosquito potential of 22 small flood-re- 
tarding reservoirs showed all of them produced mos- 
quitoes to some extent. In farm ponds, control is 
easiest when the shore line of the pond is deepened 
during construction. Investigations in Mississippi 
and Tennessee showed that there was little or no 
mosquito production in reservoir lakes where the 
shore line was deep and clean. (2) 



That in India's Malaria Eradication Campaign in 
1963, there were employed: 

1. 550 physicians and entomologists and 34,000 
spraymen. 

U.S. NAVY MEDICAL NEWS LETTER 



2. 26,000 surveillance workers, each responsible 
for a population of 10,000 living in about 2,000 
houses which were visited twice a month to detect 
fever cases. 

3. 39 million bloodsmears were taken and ex- 
amined for malaria parasites. 

4. 38 million houses were sprayed with insecti- 
cides, each house with an average sprayable surface 
of 170 square meters, a total of 6,500 square 
kilometers. 

5. 15,000 tons of DDT were used. (3) 



That rats were responsible for scrub typhus in 
Thailand? 

The Faculty of Tropical Medicine at the Univer- 
sity of Medical Sciences in Bangkok, Thailand 
report that investigations led to isolation of Rickett- 
sia tsutsugamushi from field rodents and patients. 
Various field rats seemed to be the main reservoir 
hosts. The chigger has a carrier role in transferring 
rickettsia from rats to humans. (Jour Trop Med Hyg 
67: 215-219, Sept 1964.) (4) 



That the average patient entering a mental hospi- 
tal today has a 70% to 85% chance of leaving 
the hospital considerably improved or totally recov- 
ered within a few months. (5) 



That of the 1 to 4 year-old age group of U.S. 
children last year 40% had not received a smallpox 
vaccine. (6) 



That Soviets have more physicians per 1,000 pop- 
ulation than any other country in the world? 

There are presently about 500,000 physicians and 
100,000 pharmacists in the Soviet Union. Soviet 

23 



medical authorities, however, state that the hygienic 
conditions leave something to be desired in some 
areas of the country. In remote districts such as 
Kzbek, Kirkhgisia, Patschik Republic, among others, 
there are no private or public baths because the 
water supply is either out of order or not yet avail- 
able. (7) 



That during 1963, 295 cases with 40 deaths and 
141 carriers of diphtheria were officially reported 
to the Diphtheria Surveillance Unit, CDC, Atlanta, 
27% less than had been reported in 1962. This de- 
cline has been continuous since the inauguration of 
a nationwide surveillance program. In 1921, 206,- 
989 cases were reported or 20.14 per 100,000 popu- 
lation; 0.17 per 100,000 population in 1963. Every 
year since 1946, when diphtheria toxoid and antibi- 
otics became widely available, the case rate has de- 



clined, although the case-fatality ratio has increased. 

(8) 

REFERENCES 

1. Water Newsletter, 7(1): 2, Jan 8, 1965. 

2. Water Newsletter, 7(1 ) : 3, Jan. 8, 1965. 

3. WHO Press Release, Pg 2, Jan 19, 1965. 

4. JAMA, 190(12): 1089 (133), Dec 21, 1964. 

5. Science News Letter, 86(11): 172, Sept 12, 1964. 

6. Science News Letter, 86(24): 380, Dec 12, 1964 

7. JAMA, 191(1): 165, Jan. 4, 1965. 

8. Diphtheria Surveillance Unit, Rpt No. 6, Dec 1964. 

NOTICE 

Chapter 1, "Food-Service Principles," of the 
Manual of Naval Preventive Medicine (NAVMED 
P-5010-1), has been revised, and distribution is 
anticipated in June 1965. It is recommended that 
individual holders of the Manual of Naval Preventive 
Medicine who have not sent in a change of address 
within the last year submit a change of address form 
to BUMED (Code 4561) in order to be assured 
of receiving the new Chapter 1 . 



RESERVE SECTION 



AEROSPACE MEDICAL ASSOCIATION 

The 36th Annual Meeting of the Aerospace Med- 
ical Association will be held at the New York Hilton 
Hotel, New York City, New York during the period 
26 through 29 April 1965. A Military Section in 
conjunction with this meeting will be held on the 
above dates and each session will be at least two 
hours in duration. 

By authority of the Chief of Naval Personnel, one 
retirement point may be credited to eligible Naval 
Reserve Medical Corps officers in attendance. Offi- 
cers are requested to register with the Commandant's 
Representative in order that attendance may be re- 
corded and reported. 

BRONZE STAR MEDAL AWARDED TO 
LT RICHARD R. SHULTZ 
On 21 January 1965, LT Richard R. Shultz MC 
USNR, was presented the Bronze Star Medal for 
service as set forth in the following CITATION: 

For meritorious achievement during the period 
12 October 1963 to 1 July 1964 while serving with 
Station Hospital, Headquarters Support Activity, 



Saigon, Republic of Vietnam. In addition to his 
regularly-assigned duties, LT Shultz, in his off-duty 
time, carried out a program of providing medical 
assistance to men of the Vietnamese Navy Coastal 
Force and their dependents. He visited Junk Divi- 
sion bases in remote, and, in many cases, Viet Cong 
infested areas to provide what was often the first 
professional medical treatment ever received by the 
paramilitary junk crewmen and their families. Al- 
though exposed to enemy gunfire on several occa- 
sions in conducting these visits, he continued to carry 
out his missions, winning the admiration and respect 
of the Vietnamese by his courageous conduct under 
fire. During his tour of duty, LT Shultz provided 
sorely-needed medical assistance to over 3500 per- 
sons, and initiated a program of regular medical 
visits to remote Junk Division bases which has been 
continued by the Vietnamese Navy. His leadership, 
courage, and inspiring devotion to duty were in 
keeping with the highest traditions of the United 
States Naval Service. 

S/Paul H. Nitze 
Secretary of the Navy 



PRIORITY ON SEWAGE DISPOSAL 

Sewage disposal, often the last element consid- 
ered, is getting priority in a move to attract devel- 
opers to an area of northern Virginia. 

On county-owned land near Dulles Airport, Fair- 



fax County authorities are building four compact, 
modified activated sludge sewage treatment plants 
designed to meet the needs of more than 10,000 
persons. — Public Health Reports 80(1): 10, Jan- 
uary 1965. 



24 



U.S. NAVY MEDICAL NEWS LETTER 



MISCELLANY 



PROCUREMENT, TRAINING, AND 
ASSIGNMENT OF PHARMACY TECHNICIANS 

CAPT C. V. Timberlake, Jr., MSC USN* and 
LCDR Robert L. Smith MSC USN**. 

"WANTED: Handpicked, career-minded, well- 
motivated modern Petty Officers as candidates for 
Pharmacy School" 

Thus possibly would read a want-ad, if we used 
such a system, to procure our pharmacy school can- 
didates. The criteria may appear too exacting and 
idealistic but in this fantastic era of scientific ad- 
vances and developments, particularly in the phar- 
maceutical industry, we feel there is a definite need 
for a more selective student to cope with the de- 
mands and challenges of this parade of progress. 

Modern Needs 

Not too many decades ago, the old Pharmacy and 
Chemistry School at the Naval Hospital, Washing- 
ton, D.C. turned out a select group of pharmacy 
and chemistry technicians fairly well versed in both 
sciences. They served not only in the pharmacies 
of the major naval hospitals but were frequently 
called upon to perform as toxicologists and chemical 
researchers when the occasion arose. Those were the 
days before our medical research and preventive med- 
icine units. Those were also the days when the 
medical officer had but a few potent selective agents 
and the pharmacist spent a considerable portion of 
his time compounding favorite "recipes" in the 
hopes of conquering the profusion of incurable mala- 
dies. Today, the pharmaceutical manufacturer is 
producing these time-consuming medicaments in tai- 
lor-made, ready-to-dispense form and the pharmacy 
technician is no longer primarily a compounder but 
more, a drug consultant. 

With the products of modern pharmaceutical ad- 
vances appearing en masse, the need for a highly 
trained, well motivated pharmacy technician is be- 
coming more and more acute. This accelerated pace 
demands an academically trained man. We can no 
longer afford to take a likely prospect into the phar- 

* Assistant Staff Director, Professional Services, Bureau of Medi- 
cine and Surgery, Washington. D.C. 
** Pharmacy School Officer, U.S. Naval Hospital Corps School, San 
Diego, California. 



macy as a striker and let him learn "on the job." 
He is not exposed to, nor does he master the finer 
points of the profession and eventually he will be 
at a loss without them, conceivably to the embar- 
rassment of the medical officer or the command. 

Selecton of Candidates 

The present criteria for procurement of candidates 
for pharmacy school are: 1. volunteer, 2. high 
school graduate or equivalent, 3. combined 
GCT/ARI of 1 10, 4. sufficient obligated service (36 
months), and 5. command recommendation for 
training. We feel that at times tolerant interpretation 
of items 3 and 5 have resulted in a number of stu- 
dents with boderline qualifications. 

The volunteer requirement presents a twofold 
problem: (1) we are not getting a sufficient number 
of volunteers, apparently due to lack of recruiting 
at local levels, and (2) many of the candidates we 
do obtain have invalid ulterior motives ranging from 
additional shore-duty to escape from an undesirable 
duty station. 

Waiver of the GCT/ARI requirement is by no 
means to the student's advantage. He is usually 
placed in a situation where he is at a disadvantage 
from the very beginning. Academic records indicate 
that this type of individual is a poor risk and will 
eventually be dropped for scholastic failure. 

Finally, item 5, the recommendation, many times, 
appears to be given superficial consideration at best, 
if not automatic; the intent being lost along the 
way. 

It is felt that our pharmacy officers and senior 
pharmacy technicians could greatly help alleviate 
these problems, since they in turn would be the ones 
to profit most by the finished product. These goals 
can be achieved by vigorous and realistic recruit- 
ment and personal interview. 

Desirable Attributes 

When recruiting, keep in mind the service useful- 
ness to be obtained from each candidate. Why look 
for the bright young corpsman just out of basic 
school who, although possibly having a degree of 
higher education, still lacks naval experience? What 
about the young HM3 or HM2 on the eve of re-en- 



U.S. NAVY MEDICAL NEWS LETTER 



25 



listment or discharge? It is possible that the same 
HM3 or HM2 who, having reenlisted, is now looking 
for a specialty, since he has made up his mind to 
make the Navy a career. We feel that we are over- 
looking a great number of promising young corps- 
men who could be recruited for pharmacy school 
as an inducement for re-enlistment or beginning 
a career as a hospital corps technician. 

As a possible guideline for interview, it is sug- 
gested that the candidate's educational background be 
thoroughly explored. Particular emphasis should be 
placed on chemistry and mathematics. The didactic 
training is centered heavily around these two 
sciences and 352 hours out of a total 672 are in 
these two particular subjects. Many hard working, 
well intentioned corpsmen have been assigned to this 
school who are incapable of doing even the simplest 
mathematical manipulation and appear to lack the 
basic ability to approach problems logically. These 
men, if graduated, would seriously jeopardize the 
medical profession when called upon to calculate 
the potent dosages of our modern drugs. 

The courses in chemistry are designed to impart 
a basic understanding of drug composition to the 
student, so essential in the role as drug consultant. 
There are undoubtedly a few well motivated men 
who could satisfactorily complete the course, al- 
though lacking in these prerequisites. Statistically, 
however, they are rare indeed. 

Needless to say, attributes of moral fiber and per- 
sonal responsibility should be sought. To graduate 
a student with questionable motives and demonstrat- 
ed traits of moral irresponsibility (military and civil 
infractions, marital experimentation, indebtedness 
and alcoholism) certainly is hazardous in this pro- 
fession and eventually would prove embarrassing to 
his command. 

Recruitment 

It is felt that by recruitment and personal selec- 
tion, every pharmacy officer and senior pharmacy 
technician in the field could recommend at least two 
candidates per year, thereby maintaining an ade- 
quate influx of students and graduates. 

A program is presently being considered in San 
Diego whereby contact will be maintained with the 
student after graduation. His department head will 
be asked by periodic questionnaire to evaluate his 
performance in the light of present day needs. The 
results of these surveys obviously would aid the 
school in its mission. Emphasis could be shifted, 
broadened or adjusted as necessary to meet the de- 
mands of field activities. 



Ultimate Duty Assignments 

It is economically essential that the pharmacy 
technicians be utilized in their specialty upon grad- 
uation. From the technician's standpoint, his utiliza- 
tion in this field is vital for his morale and profes- 
sional future. His training in pharmacy school 
constitutes only a foundation upon which he must 
build with learning and experience. Today's medi- 
cine demands that he maintain daily contact with 
technical advances in order to remain useful to the 
medical profession. 

The proper procurement, training, and assignment 
of pharmacy technicians will directly influence the 
ultimate recipient of their services — the patient; 
without whom our profession would be quite un- 
necessary. 

CHANGES IN ARMY PG COURSES 

Navy participation in the course "Principles of 
Military Dental Research," to be conducted at the 
U.S. Army Institute of Dental Research, Walter 
Reed Army Medical Center, Washington, D.C., 
10-14 May 1965, has been cancelled, due to space 
limitations in classroom and in programmed field 
trips. 

This change supersedes the announcement in Med- 
ical News Letter 44(8), 23 October 1964. — Train- 
ing Branch, Professional Div., BuMed. 

ANNUAL ANESTHESIOLOGY REVIEW 
SESSION FOR THE ARMED SERVICES 

Location: Wilford Hall, U. S. Air Force Hospital, 

Lackland Air Force Base, Texas 
Dates: 7 through 1 1 June 1965 

This course is designed as a review for residents 
who have completed their training in Anesthesiology 
and desire to take the American Board of Anesthe- 
siology Examination on or about 28 June 1965. 

Requests should be forwarded in accordance with 
BUMED INSTRUCTION 1520.8A at least 8 weeks 
in advance of the convening date of the course. A 
limited number of eligible officers may be provided 
with travel orders to attend at Navy expense. Others 
may be issued Authorization Orders by their Com- 
manding Officers following confirmation by the Bu- 
reau. — Training Branch, Professional Div., BuMed. 

BRONZE STAR AWARDED TO LCOL 
BRUCE S. OTT 

Washington, D. C. (AFIP)— LCOL Bruce S. Ott, 

Chief of the newly created Experimental Surgery 
Branch of the Armed Forces Institute of Pathology, 



26 



U.S. NAVY MEDICAL NEWS LETTER 




L-R: Brig Gen Joe M. Blumberg, Director of AFIP, Washington, D. C, presents 
Bronze Star citation to LCOL Bruce S. Ott, Chief of the Institute's Experimental 
Surgery Branch. Mrs. Ott and CAPT Bruce Smith, Deputy Director of the Institute, 
watch the presentation. (From: Technical Liaison Office, AFIP) 



has been awarded the Bronze Star for meritorious 
service in Vietnam. 

A grauduate of Michigan State University (DVM, 
1946), LCOL Ott received the award for his out- 
standing performance as senior veterinary advisor 
to the Republic of Vietnam Armed Forces Veterin- 
ary Service during 1964. 

The Bronze Star and citation were presented by 
Brig Gen. Joe M. Blumberg, Director of the Armed 
Forces Institute of Pathology, in special ceremonies 
attended by COL Stephen Asbill, Chief of the Army 
Veterinary Corps; COL Wilson M. Osteen, Deputy 
Assistant for Veterinary Services, Office of the Sur- 
geon General; COL Robert C. Yager, Director of 
the Division of Veterinary Medicine, Walter Reed 
Army Institute of Research; and more than a score 
of key AFIP personnel. 



The citation accompanying the Bronze Star sta- 
ted: "Through his untiring efforts and professional 
ability, he consistently obtained outstanding results. 
He was quick to grasp the implications of new prob- 
lems with which he was faced as a result of the 
ever changing situations inherent in a counterinsur- 
gency operation and to find new ways and means 
to solve those problems. The energetic application 
of his extensive knowledge has materially contribut- 
ed to the efforts of the United States Mission to 
the Republic of Vietnam to assist that country in 
ridding itself of the communist threat to its 
freedom." 

A native of Allentown, Pa., LCOL Ott assumed 
his new duties as head of the AFIP Experimental 
Surgery Branch Jan. 21, 1965. 



AID IN POISON IDENTIFICATION 

An infrared spectrophotometer aids chemists at 
the Florida State Board of Health in identifying poi- 



sons, drugs, and narcotics. The instrument can 
"name" any one of over 20,000 organic substances 
in 10 minutes. — Public Health Reports 80(1): 10, 
January 1965. 



U.S. NAVY MEDICAL NEWS LETTER 



27 



DEPARTMENT OF THE NAVY 

U. S. NAVAL MEDICAL SCHOOL 

NATIONAL NAVAL MEDICAL CENTER 

BETHESDA. MARYLAND 20014 

OFFICIAL BUSINESS 
PERMIT NO. I04S 



POSTAGE AND FEES PAID 
NAVY DEPARTMENT 



U.S. NAVY MEDICAL NEWS LETTER